Evidence-Based Practice Committee

How Can EBP Improve Your Practice?

Staying abreast of best research evidence, and integrating it into your practice enables you to continuously improve patient care. Collecting outcomes information on your patients allows you to continuously assess your practice, and make modifications to improve patient care.

In our continuing effort to educate AAOS members about implementing evidence-based practice, the committee will be writing regular articles for inclusion in the Bulletin. As a service to our members and other interested parties, the EBPC will also make these articles available here.

Orthopaedic Integration of Evidence-Based Practice: Focus on Quality Musculoskeletal Care    This article introduces the newly formed Evidence Based Practice Committee, describes the Improving Musculoskeletal Care in America (IMCA) project, reviews results of the evidence-based practice survey of AAOS members, and identifies ongoing collaborative efforts in clinical quality improvement activities.

Levels of Evidence and Grades of Recommendation

• Levels of Evidence: A Step Forward on the Road to Better Practice?    This article provides an introduction to levels of evidence. It defines the five different levels of evidence, identifies potential uses, and discusses implications and effects of using levels of evidence.
• Levels of Evidence (PDF)    This document identifies the various types of studies conducted and lists what would constitute a given level for each type of study.
• Grades of Recommendation    This page lists the various grades of recommendations that would be applied to reviews or summaries of orthopaedic surgical studies.

Summarizing the evidence: Gaining confidence in treatment recommendations.     This article is directed to those clinicians who want summaries of the literature addressing clinical questions. The article begins with a clinical question, describes possible sources of information to answer clinical questions, and finally, proposes an evidence-based approach to clinical questions.

Evidence-based practice and the use of practice guidelines: Creating order out of chaos in clinical decision-making    It is difficult to over-emphasize the importance of practice guidelines in contemporary clinical orthopaedics. In the broadest sense, practice guidelines are fundamental to the clinical quality improvement cycle that drives ever-improving patient care. This article is intended to help members understand the purpose of clinical practice guidelines and the role they play in improving quality of care.

Knowing is not enough: Implementation of performance measures to improve quality    The Institute of Medicine’s (IOM) 2001 Report "Crossing the Quality Chasm" clearly identifies that there is a gap between knowledge and practice. Disparities between what is known to be "best practice" and what is actually practiced underscores the urgent need to improve clinical performance and the quality of care and reduce medical errors. This article addresses the role performance measurement plays in improving the quality of care.

The importance of outcomes research    Although there continue to be challenges to the design and conduct of rigorous patient-oriented outcomes research, improvements in the methodology and infrastructure promise to improve our ability to perform clinical research and to better understand how we can best serve our patients. This article strives to illustrate the importance of outcomes research to orthopaedic practice.

Joint registries and the lessons learned from MODEMS     The failure to establish a long-term, valid data base of patients was disheartening, however, the analysis showed that the MODEMS experience simply highlighted common pitfalls in outcomes research and in establishing joint registries. Through lessons learned from MODEMS and others, the institution of future large-scale data collection projects like the American Joint Replacement Registry (AJRR) will be successful.

On February 7, 2003 the Evidence-Based Practice Committee (EBPC) held it's first symposium, entitled "Saving Time and Money with Evidence-Based Practice". As a service to other interested parties, the EBPC is making an overview of this topic available. Please see the introduction or review an outline of the material covered.