Posted: September 18th, 2023

Evidence-based practice and the quadruple aim in healthcare

Evidence-based practice and the quadruple aim in healthcare
How Evidence-Based Practice Can Help Achieve the Quadruple Aim in Healthcare

Evidence-based practice (EBP) is a problem-solving approach to healthcare delivery that integrates the best available evidence from well-designed studies with the clinician’s expertise and the patient’s preferences and values. EBP has been shown to improve healthcare quality, patient outcomes and cost-effectiveness, while also enhancing clinician satisfaction and well-being. These benefits align with the quadruple aim in healthcare, which is a framework that aims to improve the health of populations, enhance the patient experience of care, reduce the per capita cost of healthcare, and improve the work life of healthcare providers.

In this blog post, we will discuss how EBP can help achieve the quadruple aim in healthcare, what are the current challenges and barriers to implementing EBP in healthcare settings, and what are some effective strategies and resources to promote and sustain EBP among healthcare professionals.

EBP and the Quadruple Aim: The Evidence

There is ample evidence to support the positive impact of EBP on the quadruple aim in healthcare. Here are some examples of how EBP can help achieve each of the four aims:

– Improving the health of populations: EBP can help prevent or reduce the burden of chronic diseases, infections, complications, and adverse events by implementing interventions that are based on the best available evidence. For instance, a nurse-led team in a long-term acute care hospital implemented a nurse-driven protocol for evaluating the appropriateness of short-term urinary catheter continuation or removal, based on a systematic review of 15 studies. The protocol resulted in a significant reduction in catheter days and catheter-associated urinary tract infections (CAUTIs), which are common and costly healthcare-associated infections (Magers, 2015).

– Enhancing the patient experience of care: EBP can help improve patient satisfaction, engagement, empowerment, and quality of life by providing care that is consistent with the patient’s values and preferences, and by involving them in shared decision making. For example, a systematic review of 18 studies found that shared decision making interventions for people with mental health conditions improved their knowledge, decisional conflict, adherence, satisfaction, and outcomes (Duncan et al., 2010).

– Reducing the per capita cost of healthcare: EBP can help reduce unnecessary or ineffective tests, treatments, procedures, or hospitalizations by using evidence-based guidelines, protocols, or pathways that optimize resource utilization and avoid waste. For example, a meta-analysis of 16 studies found that clinical pathways for patients undergoing surgery reduced hospital length of stay, hospital costs, and complications (Rotter et al., 2010).

– Improving the work life of healthcare providers: EBP can help enhance clinician competence, confidence, autonomy, leadership, collaboration, and innovation by providing them with the skills and tools to access, appraise, and apply evidence in their practice. EBP can also improve clinician well-being, resilience, and joy by reducing stress, burnout, moral distress, and turnover. For example, a randomized controlled trial of 24 hospitals found that an EBP mentorship program for nurses improved their EBP knowledge, skills, beliefs, culture, implementation, and job satisfaction (Melnyk et al., 2018).

Challenges and Barriers to EBP Implementation

Despite the clear benefits of EBP for achieving the quadruple aim in healthcare,
many challenges and barriers hinder its widespread adoption and implementation in healthcare settings. Some of these barriers include:

– Lack of time, resources, skills, or access to search and appraise evidence
– Lack of organizational culture, leadership support, or incentives for EBP
– Lack of interdisciplinary collaboration or communication for EBP
– Resistance to change or preference for tradition or intuition over evidence
– Complexity or variability of patient situations or preferences
– Conflicting or low-quality evidence or guidelines

Strategies and Resources to Promote and Sustain EBP

To overcome these barriers and foster a culture of EBP in healthcare organizations,
several strategies and resources can be used to facilitate and sustain EBP among healthcare professionals. Some of these strategies and resources include:

– Providing education and training on EBP competencies for clinicians at all levels
– Creating dedicated time and space for EBP activities such as journal clubs or rounds
– Establishing EBP mentors or champions who can role model and guide EBP implementation
– Developing organizational policies or protocols that support or mandate EBP
– Providing feedback or recognition for EBP achievements or improvements
– Engaging stakeholders such as patients, families, managers, or policymakers in EBP processes
– Using online tools or databases that provide access to high-quality evidence or guidelines such as Cochrane Library (https://www.cochranelibrary.com/), PubMed (https://pubmed.ncbi.nlm.nih.gov/), or U.S. Preventive Services Task Force (https://www.uspreventiveservicestaskforce.org/)

Conclusion

EBP is a key strategy to achieve the quadruple aim in healthcare, which is a vision for improving healthcare quality, patient outcomes, cost-effectiveness, and clinician well-being. EBP requires a systematic and collaborative approach that integrates the best available evidence with the clinician’s expertise and the patient’s preferences and values. EBP faces many challenges and barriers in healthcare settings, but these can be overcome by using effective strategies and resources that promote and sustain EBP among healthcare professionals.

Works Cited

Duncan, E., Best, C., & Hagen, S. (2010). Shared decision making interventions for people with mental health conditions. Cochrane Database of Systematic Reviews, 2010(1), CD007297. https://doi.org/10.1002/14651858.CD007297.pub2

Magers, T. L. (2015). Reducing catheter-associated urinary tract infections in the ICU by using a nurse-driven protocol for timely catheter removal. American Journal of Critical Care, 24(4), 358-363. https://doi.org/10.4037/ajcc2015298

Melnyk, B. M., Gallagher-Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2018). The first US study on nurses’ evidence-based practice competencies indicates major deficits that threaten healthcare quality, safety, and patient outcomes. Worldviews on Evidence-Based Nursing, 15(1), 16-25. https://doi.org/10.1111/wvn.12269 – write my essay online.

Rotter, T., Kinsman, L., James, E., Machotta, A., Gothe, H., Willis, J., Snow, P., & Kugler, J. (2010). Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database of Systematic Reviews, 2010(3), CD006632. https://doi.org/10.1002/14651858.CD006632.pub2

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