Evidence-based practice (EBP) is the idea that occupational practices ought to be based on
scientific evidence
Scientific evidence is evidence that serves to either support or counter a scientific theory or hypothesis, although scientists also use evidence in other ways, such as when applying theories to practical problems. "Discussions about empirical ev ...
. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to individuals as well as traditional practices. Evidence-based practices have been gaining ground since the formal introduction of
evidence-based medicine in 1992 and have spread to the
allied health professions,
education
Education is a purposeful activity directed at achieving certain aims, such as transmitting knowledge or fostering skills and character traits. These aims may include the development of understanding, rationality, kindness, and honesty. ...
,
management,
law,
public policy,
architecture
Architecture is the art and technique of designing and building, as distinguished from the skills associated with construction. It is both the process and the product of sketching, conceiving, planning, designing, and constructing buildings ...
, and other fields. In light of studies showing problems in scientific research (such as the
replication crisis), there is also a movement to apply evidence-based practices in scientific research itself. Research into the evidence-based practice of science is called
metascience.
The movement towards evidence-based practices attempts to encourage and, in some instances, require professionals and other decision-makers to pay more attention to evidence to inform their decision-making. The goal of evidence-based practice is to eliminate unsound or outdated practices in favor of more-effective ones by shifting the basis for decision making from tradition, intuition, and unsystematic experience to firmly grounded scientific research.
History
For most of history, professions have based their practices on expertise derived from experience passed down in the form of
tradition
A tradition is a belief or behavior (folk custom) passed down within a group or society with symbolic meaning or special significance with origins in the past. A component of cultural expressions and folklore, common examples include holidays ...
. Many of these practices have not been justified by evidence, which has sometimes enabled
quackery
Quackery, often synonymous with health fraud, is the promotion of fraudulent or ignorant medical practices. A quack is a "fraudulent or ignorant pretender to medical skill" or "a person who pretends, professionally or publicly, to have skill, ...
and poor performance. Even when overt quackery is not present, quality and efficiency of tradition-based practices may not be optimal. As the
scientific method
The scientific method is an Empirical evidence, empirical method for acquiring knowledge that has characterized the development of science since at least the 17th century (with notable practitioners in previous centuries; see the article hist ...
has become increasingly recognized as a sound means to evaluate practices, evidence-based practices have become increasingly adopted.
One of the earliest proponents of EBP was
Archie Cochrane, an
epidemiologist
Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population.
It is a cornerstone of public health, and shapes policy decisions and evidenc ...
who authored the book ''Effectiveness and Efficiency: Random Reflections on Health Services'' in 1972. Cochrane's book argued for the importance of properly testing health care strategies, and was foundational to the evidence-based practice of medicine. Cochrane suggested that because resources would always be limited, they should be used to provide forms of health care which had been shown in properly designed evaluations to be effective. Cochrane maintained that the most reliable evidence was that which came from
randomised controlled trials.
The term "
evidence-based medicine" was introduced by
Gordon Guyatt in 1990 in an unpublished program description, and the term was later first published in 1992. This marked the first evidence-based practice to be formally established. Some early experiments in evidence-based medicine involved testing primitive medical techniques such as
bloodletting
Bloodletting (or blood-letting) is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily flu ...
, and studying the effectiveness of modern and accepted treatments. There has been a push for evidence-based practices in medicine by
insurance
Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge ...
providers, which have sometimes refused coverage of practices lacking in systematic evidence of usefulness. It is now expected by most clients that medical professionals should make decisions based on evidence, and stay informed about the most up-to-date information. Since the widespread adoption of evidence-based practices in medicine, the use of evidence-based practices has rapidly spread to other fields.
More recently, there has been a push for
evidence-based education. The use of
evidence-based learning techniques such as
spaced repetition can improve students' rate of learning. Some commentators have suggested that the lack of any substantial progress in the field of education is attributable to practice resting in the unconnected and noncumulative experience of thousands of individual teachers, each re-inventing the wheel and failing to learn from hard scientific evidence about 'what works'. Opponents of this view argue that it is hard to assess teaching methods because it depends on a host of factors, not least those to do with the style, personality and beliefs of the teacher and the needs of the particular children. Others argue the teacher experience could be combined with research evidence, but without the latter being treated as a privileged source. This is inline with a school of thought suggesting that EBP has limitations and a better alternative is to use ''Evidence-informed Practice (EIP)''. This process includes quantitative evidence, does not include non-scientific prejudices, but includes qualitative factors such as clinical experience and the discernment of practitioners and clients.
Versus tradition
Evidence-based practice is a philosophical approach that is in opposition to
tradition
A tradition is a belief or behavior (folk custom) passed down within a group or society with symbolic meaning or special significance with origins in the past. A component of cultural expressions and folklore, common examples include holidays ...
. Some degree of reliance on "the way it was always done" can be found in almost every profession, even when those practices are contradicted by new and better information.
Some critics argue that since research is conducted on a population level, results may not generalise to each individual within the population. Therefore, evidence-based practices may fail to provide the best solution to each individual, and traditional practices may better accommodate individual differences. In response, researchers have made an effort to test whether particular practices work better for different subcultures, personality types etc. Some authors have redefined EBP to include practice that incorporates common wisdom, tradition, and personal values alongside practices based on evidence.
[
]
Evaluating evidence
Evaluating scientific research is extremely complex. The process can by greatly simplified with the use of a heuristic
A heuristic (; ), or heuristic technique, is any approach to problem solving or self-discovery that employs a practical method that is not guaranteed to be optimal, perfect, or rational, but is nevertheless sufficient for reaching an immediat ...
that ranks the relative strengths of results obtained from scientific research called a hierarchy of evidence. The design of the study and the endpoints measured (such as survival or quality of life
Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
) affect the strength of the evidence. Typically, systematic review
A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on t ...
s and meta-analysis
A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting m ...
rank at the top of the hierarchy while randomized controlled trials rank above observational studies, and expert opinion and case report In medicine, a case report is a detailed report of the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. Case reports may contain a demographic profile of the patient, but usually describe an unusual or novel occurr ...
s rank at the bottom. There is broad agreement on the relative strength of the different types of studies, but there is no single, universally-accepted hierarchy of evidence. More than 80 different hierarchies have been proposed for assessing medical evidence.
Applications
Medicine
Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making
In psychology, decision-making (also spelled decision making and decisionmaking) is regarded as the cognitive process resulting in the selection of a belief or a course of action among several possible alternative options. It could be either r ...
by emphasizing the use of evidence from well-designed and well-conducted research
Research is "creative and systematic work undertaken to increase the stock of knowledge". It involves the collection, organization and analysis of evidence to increase understanding of a topic, characterized by a particular attentiveness t ...
. Although all medicine based on science
Science is a systematic endeavor that Scientific method, builds and organizes knowledge in the form of Testability, testable explanations and predictions about the universe.
Science may be as old as the human species, and some of the earli ...
has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic
Epistemology (; ), or the theory of knowledge, is the branch of philosophy concerned with knowledge. Epistemology is considered a major subfield of philosophy, along with other major subfields such as ethics, logic, and metaphysics.
Ep ...
strength and requiring that only the strongest types (coming from meta-analyses, systematic review
A systematic review is a scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from published studies on t ...
s, and randomized controlled trial
A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical ...
s) can yield strong recommendations; weaker types (such as from case-control studies) can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations ("evidence-based practice policies").
Whether applied to medical education, decisions about individuals, guidelines and policies applied to populations, or administration of health services in general, evidence-based medicine advocates that to the greatest extent possible, decisions and policies should be based on evidence, not just the beliefs of practitioners, experts, or administrators. It thus tries to assure that a clinician's opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge from the scientific literature
: ''For a broader class of literature, see Academic publishing.''
Scientific literature comprises scholarly publications that report original empirical and theoretical work in the natural and social sciences. Within an academic field, sci ...
so that best practice can be determined and applied. It promotes the use of formal, explicit methods to analyze evidence and makes it available to decision makers. It promotes programs to teach the methods to medical students, practitioners, and policymakers.
A process has been specified that provides a standardised route for those seeking to produce evidence of the effectiveness of interventions. Originally developed to establish processes for the production of evidence in the housing sector, the standard is general in nature and is applicable across a variety of practice areas and potential outcomes of interest.
Mental health
To improve dissemination of evidence-based practices, th
Association for Behavioral and Cognitive Therapies (ABCT)
and the Society of Clinical Child and Adolescent Psychology ( SCCAP, Division 53 of the American Psychological Association
The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It has ...
) maintain updated information on their websites on evidence-based practices in psychology for practitioners and the general public. An evidence-based practice consensus statement was developed at a summit on mental healthcare in 2018. As of June 23, 2019, this statement has been endorsed by 36 organizations.
Metascience
There has since been a movement for the use of evidence-based practice in conducting scientific research in attempt to address the replication crisis and other major issues affecting scientific research. The application of evidence-based practices to research itself is called metascience, which seeks to increase the quality of scientific research while reducing waste. It is also known as "research on research" and "the science of science", as it uses research methods to study how research is done and where improvements can be made. The five main areas of research in metascience are methodology, reporting, reproducibility, evaluation
Evaluation is a
systematic determination and assessment of a subject's merit, worth and significance, using criteria governed by a set of standards. It can assist an organization, program, design, project or any other intervention or initiative ...
, and incentives. Metascience has produced a number of reforms in science such as the use of study pre-registration and the implementation of reporting guidelines Reporting may refer to
* any activity that leads to reports
* in particular business reporting
*Data reporting
*Sustainability reporting
*Financial reporting
* international reporting of financial information for tax purposes under the OECD's Commo ...
with the goal of bettering scientific research practices.
Education
Evidence-based education (EBE), also known as ''evidence-based interventions'', is a model in which policy-makers and educators use empirical evidence to make informed decisions about education interventions (policies, practices, and programs). In other words, decisions are based on scientific evidence rather than opinion.
EBE has gained attention since English author David H. Hargreaves suggested in 1996 that education would be more effective if teaching, like medicine, was a "research-based profession".
Since 2000, studies in Australia, England, Scotland and the USA have supported the use of research to improve educational practices in teaching reading.
In 1997, the National Institute of Child Health and Human Development
The ''Eunice Kennedy Shriver'' National Institute of Child Health and Human Development (NICHD) is one of the National Institutes of Health (NIH) in the United States Department of Health and Human Services. It supports and conducts research aime ...
(NICHD) convened a national panel to assess the effectiveness of different approaches used to teach children to read. The resulting National Reading Panel examined quantitative research studies on many areas of reading instruction, including phonics and whole language. In 2000 it published a report entitled ''Teaching Children to Read: An Evidence-based Assessment of the Scientific Research Literature on Reading and its Implications for Reading Instruction'' that provided a comprehensive review of what was known about best practices in reading instruction in the U.S.
This occurred around the same time as such international studies as the Programme for International Student Assessment
The Programme for International Student Assessment (PISA) is a worldwide study by the Organisation for Economic Co-operation and Development (OECD) in member and non-member nations intended to evaluate educational systems by measuring 15-yea ...
(PISA) in 2000 and the Progress in International Reading Literacy Study (PIRLS) in 2001.
Subsequently, evidence-based practice (EBP) in education (also known as Scientifically based research), came into prominence in the U.S.A. under the No child left behind act
The No Child Left Behind Act of 2001 (NCLB) was a U.S. Act of Congress that reauthorized the Elementary and Secondary Education Act; it included Title I provisions applying to disadvantaged students. It supported standards-based educati ...
of 2001, replace in 2015 by the Every Student Succeeds Act (ESSA).
In 2002 the U.S. Department of Education founded the Institute of Education Sciences (IES) to provide scientific evidence to guide education practice and policy .
English author Ben Goldacre advocated in 2013 for systemic change and more randomized controlled trial
A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical ...
s to assess the effects of educational interventions. In 2014 the National Foundation for Educational Research, Berkshire, England published a report entitled ''Using Evidence in the Classroom: What Works and Why''. In 2014 the British Educational Research Association (BERA) and the Royal Society of Arts
The Royal Society for the Encouragement of Arts, Manufactures and Commerce (RSA), also known as the Royal Society of Arts, is a London-based organisation committed to finding practical solutions to social challenges. The RSA acronym is used m ...
(RSA) advocated for a closer working partnership between teacher-researchers and the wider academic research community.
Reviews of existing research on education
The following websites offer free analysis and information on education research:
* ''The Best Evidence Encyclopedia'' (BEE) is a free website created by the Johns Hopkins University
Johns Hopkins University (Johns Hopkins, Hopkins, or JHU) is a private research university in Baltimore, Maryland. Founded in 1876, Johns Hopkins is the oldest research university in the United States and in the western hemisphere. It consiste ...
School of Education's Center for Data-Driven Reform in Education (established in 2004) and is funded by the Institute of Education Sciences, U.S. Department of Education. It gives educators and researchers reviews about the strength of the evidence supporting a variety of English programs available for students in grades K–12. The reviews cover programs in areas such as ''Mathematics, Reading, Writing, Science, Comprehensive school reform, and Early childhood Education''; and includes such topics as ''effectiveness of technology and struggling readers''.
* ''The Education Endowment Foundation'' was established in 2011 by The Sutton Trust, as a lead charity in partnership with Impetus Trust, together being the government-designated What Works Centre for UK Education.
* ''Evidence for ESSA'' began in 2017 and is produced by the Center for Research and Reform in Education (CRRE) at Johns Hopkins University School of Education. It offers free up-to-date information on current PK-12 programs in reading, writing, math, science, and others that meet the standards of the Every Student Succeeds Act (ESSA) (the United States K–12 public education policy signed by President Obama in 2015).. It also provides information on programs that do meet ESSA standards as well as those that do not.
* ''What Works Clearinghouse'' (WWC), established in 2002, evaluates numerous educational programs, in twelve categories, by the quality and quantity of the evidence, and the effectiveness. It is operated by the federal National Center for Education Evaluation, and Regional Assistance (NCEE), part of Institute of Education Sciences (IES)[
* ''Social programs that work'' is administered by the ]Arnold Ventures LLC
Arnold Ventures LLC (formerly known as The Laura and John Arnold Foundation) is focused on evidence-based giving in a wide range of categories including: criminal justice, education, health care, and public finance. The organization was founded by ...
's Evidence-Based Policy team. The team is composed of the former leadership of the ''Coalition for Evidence-Based Policy'', a nonprofit, nonpartisan organization advocating the use of well-conducted ''randomized controlled trial
A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical ...
s'' (RCTs) in policy decisions.[http://toptierevidence.org/ Social programs that work] It offers information on twelve types of social programs including education.
A variety of other organizations offer information on research and education.
See also
* Evidence-based assessment
Evidence-based assessment (EBA) refers to the use of research and theory to guide the selection of constructs to be used for a specific assessment purpose and to inform the methods and measures used in the assessment process. It involves the re ...
* Evidence-based conservation
* Evidence-based dentistry
* Evidence-based design
* Evidence-based education
* Evidence-based legislation
Evidence-based legislation (EBL) is a legislative concept which calls for the use of the best available scientific evidence and systematically collected data, when available, by legislatures as a basis for their formulation and writing of law. Evi ...
* Evidence-based library and information practice
Evidence-based library and information practice (EBLIP) or evidence-based librarianship (EBL) is the use of evidence-based practices (EBP) in the field of library and information science (LIS). This means that all practical decisions made within ...
* Evidence-based management
* Evidence-based medical ethics
* Evidence-based medicine
Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients". The aim of EBM is to integrate the experience of the clinician, the values of t ...
* Evidence-based nursing
Evidence-based nursing (EBN) is an approach to making quality decisions and providing nursing care based upon personal clinical expertise in combination with the most current, relevant research available on the topic. This approach is using evi ...
* Evidence-based pharmacy in developing countries
Many developing nations have developed national drug policies, a concept that has been actively promoted by the WHO. For example, the national drug policy for Indonesia drawn up in 1983 had the following objectives:
* To ensure the availabili ...
* Evidence-based philanthropy
Effective altruism is a philosophical and social movement that advocates "using evidence and reason to figure out how to benefit others as much as possible, and taking action on that basis". People who pursue the goals of effective altruism, cal ...
—effective altruism
* Evidence-based policing
* Evidence-based policy
Evidence-based policy is an idea in public policy proposing that policy decisions should be based on, or informed by, rigorously established objective evidence. The implied contrast is with policymaking based on ideology, 'common sense,' anecd ...
* Evidence-based research—metascience
* Evidence-based scheduling
* Evidence-based toxicology
The discipline of evidence-based toxicology (EBT) strives to transparently, consistently, and objectively assess available scientific evidence in order to answer questions in toxicology, the study of the adverse effects of chemical, physical, or b ...
* Impact evaluation
References
External links
*
{{DEFAULTSORT:Evidence-Based Practice
Health care quality
Scientific method