Goal of EBM
EBM has one goal: to improve the health of people through decisions that will maximise their health-related quality of life and life span. The decisions may be in relation to public health, health care, clinical care, nursing care or health policy.
Principles of EBM
Two fundamental principles include:
(a) Hierarchy of evidence
It says that evidence available in any clinical decision making can be arranged in order of strength based on likelihood of freedom from error. For example, for treatment decisions, meta-analyses of well conducted large randomised trials may be the strongest evidence, followed in sequence by large multi-centric randomised trials, meta-analyses of well conducted small randomised trials, single-centre randomised trials, observational studies, clinical experience or basic science research.
(b) Insufficiency of evidence alone
The second fundamental principle of EBM is that evidence alone is never suffi cient for decision-making. It has to be integrated with clinical expertise and patients’ expectations and values. This principle gives rise to considerations of components of EBM which follows below.
What is Evidence-based Medicine?
EBM is a new paradigm of clinical practice and a process of lifelong learning, which emphasises a systematic and rigorous assessment of evidence for use in decision-making in health care in conjunction with expertise of the decision makers and expectations and values of the patients.
Knowing About EBM (1-2-3-4)
Knowing EBM is like knowing 1-2-3-4. EBM has
- one goal,
- two fundamental principles,
- three components and
- four steps.
One goal is
- to improve quality of clinical care;
Two principles are
- hierarchy of evidence and
- insufficiency of evidence alone in decision-making;
Three components are
- evidence,
- expertise and
- expectations of patients (triple Es); and
four steps are
- ask,
- acquire,
- assess and
- apply (4 As).
In Summary
