Can evidence-based medicine and clinical quality improvement learn from each other?

Paul Glasziou, Greg Ogrinc, Steve Goodman, Paul Glasziou, Greg Ogrinc, Steve Goodman

Abstract

The considerable gap between what we know from research and what is done in clinical practice is well known. Proposed responses include the Evidence-Based Medicine (EBM) and Clinical Quality Improvement. EBM has focused more on 'doing the right things'--based on external research evidence--whereas Quality Improvement (QI) has focused more on 'doing things right'--based on local processes. However, these are complementary and in combination direct us how to 'do the right things right'. This article examines the differences and similarities in the two approaches and proposes that by integrating the bedside application, the methodological development and the training of these complementary disciplines both would gain.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Relationships between Quality Improvement (QI) and Evidence-Based Medicine (EBM). (a) sequence of EBM followed by QI; (b) EBM uses clinical knowledge to inform individual clinical decisions about patient care; (c) QI focuses on improving recurrent problems in the processes of care (Acronyms: GIN—Guidelines International Network; EPOC—Effective Practice and Organisation of Care Group; IHI—Institute for Healthcare Improvement; BEME—Best Evidence Medical Education).
Figure 2
Figure 2
Proposed linkage between EBM and one model for QI.

References

    1. Asch SM, Kerr EA, Keesey J, et al. Who is at greatest risk for receiving poor-quality health care? N Engl J Med 2006;354:1147–56
    1. Evidence-Based Medicine Working Group Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992;268:2420–5
    1. Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn't. BMJ 1996;312:71–2
    1. Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med 1989;320:53–6
    1. Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care 2007;16:2–3
    1. Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the “evidence cart”. JAMA 1998;280:1336–8
    1. Irwig L. An Approach to Evaulating Health Outcomes. NSW Pub Health Bull 1994;4:135–6
    1. Shojania KG, Ranji SR, McDonald KM, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA 2006;296:427–40
    1. Lehman R, Krumholz HM. Glycated haemoglobin below 7%. No to QOF target of less than 7%, again. BMJ 2010;340:c985.
    1. Glass J, Lanctôt KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005;331:1169.
    1. Heather N, Bowie A, Ashton H, et al. Randomized Controlled trial of two brief interventions against long-term benzodiazepine use: outcome of interventions. Addiction Research and Theory 2004:141–54
    1. Straus SE, Ball C, Balcombe N, et al. Teaching evidence-based medicine skills can change practice in a community hospital. J Gen Intern Med 2005;20:340–3
    1. Dixon-Woods M, Amalberti R, Goodman S, et al. Problems and promises of innovation: why healthcare needs to rethink its love/hate relationship with the new. BMJ Qual Saf 2011;20(S1):i47–i51
    1. Ogrinc G, Batalden PB. Realist evaluation as a framework for the assessment of teaching about the improvement of care. J Nurs Educ 2009;48:661–7
    1. Langley GL, Nolan KM, Nolan TW, et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. San Francisco: Jossey-Bass, 1996
    1. Glasziou P. Applying evidence: what's the next action? Evid Based Med 2008;13:164–5
    1. Schouten LM, Hulscher ME, van Everdingen JJ, et al. Evidence for the impact of quality improvement collaboratives: systematic review. BMJ 2008;336:1491–4
    1. Soll R, Ozek E. Prophylactic protein free synthetic surfactant for preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev 2010;(1):CD001079.
    1. Howick J, Aronson J, Glasziou P. Evidence-based mechanistic reasoning. JRSM 2010;103:433–41 (accepted).
    1. Shojania KG, Jennings A, Mayhew A, et al. Effect of point-of-care computer reminders on physician behaviour: a systematic review. CMAJ 2010;182:E216–25
    1. Scura G, Davidoff F. Case-related use of the medical literature. Clinical librarian services for improving patient care. JAMA 1981;245:50–2
    1. Mulvaney SA, Bickman L, Giuse NB, et al. A randomized effectiveness trial of a clinical informatics consult service: impact on evidence-based decision-making and knowledge implementation. J Am Med Inform Assoc 2008;15:203–11 Epub 2007 Dec 20.
    1. Glasziou P, Vandenbroucke JP, Chalmers I. Assessing the quality of research. BMJ 2004;328:39–41
    1. Glasziou P, Chalmers I, Rawlins M, et al. When are randomised trials unnecessary? Picking signal from noise. BMJ 2007;334:349–51
    1. Batalden PB. ‘Building Knowledge for Improvement - An Introductory Guide to the Use of FOCUS-PDCA,’ Quality Resource Group, Hospital Corporation of America. Nashville, TN, 1992
    1. Kolb D. Experiential Learning: Experience as the Source of Learning and Development. Upper Saddle River, NJ: Prentic Hall, 1984
    1. McCulloch P, Altman DG, Campbell WB, et al. Nicholl J for the Balliol Collaboration No surgical innovation without evaluation: the IDEAL recommendations. Lancet 2009;374:1105–12
    1. Mackenzie M, O'Donnell C, Halliday E, et al. Do health improvement programmes fit with MRC guidance on evaluating complex interventions? BMJ 2010;340:c185.
    1. Coomarasamy A, Khan KS. What is the evidence that postgraduate teaching in evidence based medicine changes anything? A systematic review. BMJ 2004;329:1017.

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