Evaluate the outcome

• use standardised outcome measures
• keep track of your outcomes
• assess your performance

Original Editor - Rachael Lowe

Top Contributors - Admin, Rachael Lowe and WikiSysop  

Introduction

Arguably this is the most improtant step of the EBP process.  Self-assessment of practice begins as a student in the form of self-observation and judgmental processing and should continue through one’s professional career. The skills of self-awareness assist clinicians in identifying personal strengths as well as limitations. It is with reflective practice that physical therapists will refine their efficiency with integrating the best available evidence into clinical practice.

Evaluation of practice

Straus et al have developed a series of questions to facilitate introspective self-evaluation for the evidence-based practitioner:

Self-evaluation in asking answerable questions

1. Am I asking any clinical questions at all?
2. Am I asking well-formulated questions about background knowledge and foreground diagnosis/management?
3. Am I using a 'map' to locate my knowledge gaps and articulate questions?
4. Can I get myself 'unstuck' when asking questions?
5. Do I have a working method to save my questions for later answering?

A self-evaluation in finding the best external evidence

1. Am I searching at all?
2. Do I know the best sources of current evidence for my clinical discipline?
3. Have I achieved immediate access to searching hardware, software, and the best  evidence for my clinical discipline?
4. Am I finding useful external evidence from a widening array of sources?
5. Am I becoming more efficient in my searching?
6. Am I using truncations, Booleans, MeSH headings, thesaurus, limiters, and intelligent free text when searching MEDLINE?
7. How do my searches compare with those of research librarians or other respected colleagues who have a passion for providing best current patient care?

A self-evaluation in critically appraising the evidence for its validity and potential
usefulness

1. Am I critically appraising external evidence at all?
2. Are the critical appraisal guides becoming easier for me to apply?
3. Am I becoming more accurate and efficient in applying some of the critical appraisal measures (such as likelihood ratios, NNTs, and the like)?
4. Am I creating any appraisal summaries?

A self-evaluation in integrating the critical appraisal with clinical expertise and applying
the result in clinical practice

1. Am I integrating my critical appraisals into my practice at all?
2. Am I becoming more accurate and efficient in adjusting some of the critical appraisal measures to fit my individual patients (pretest probabilities, NNT/f, etc.)?
3. Can I explain (and resolve) disagreements about management decisions in terms of this integration?

A self-evaluation of changing practice behavior

1. When new evidence suggests a change in practice, am I identifying barriers to this change?
2. Have I carried out any check, such as audits of my diagnostic, therapeutic, or other EBM performance?

Outcome Measures

Therapists should reflect subjectively on their ability to proceed through the first 4 steps of EBP, but should also assess patient outcomes objectively and formally in the context of best available evidence. We should use reliable and valid outcome measures for every patient we see in clinical practice to ascertain if true and clinically meaningful changes in patient status occurred.

The data obtained through the use of valid and reliable outcomes tools, along with the self-evaluation of effectiveness and efficiency with the 4 steps, will enhance clinical practice.

Resources

The Evidence for Evidence-Based Practice Implementation