As it is known, all types of research have one main goal – to obtain new knowledge or to test existing ones based on some theory. Systematic scientific research is part of more extensive scientific research and seeks to answer research questions. In addition, there may be disciplined theories or hypotheses that must be tested to achieve some goal through various methods. Researchers must use the scientific form in orderly, sequential steps for the results obtained to be considered reliable and valid. Evidence-based medicine and quality improvement are among health systems’ most frequently used research methods. Evidence-based medicine is regarded as one of the most significant medical advances of the 20th century and has had an impact far beyond healthcare, from ‘evidence-based politics’ to ‘evidence-based preservation’ (Tebala, 2018). With increasing interest in incorporating quality improvement into everyday clinical practice, comparing quality improvement with evidence-based medicine may inform the future progress of the quality improvement movement.
Understanding Evidence-Based Practice
Evidence-Based Practice (EBP), unlike conventional scientific research, does not seek to confirm existing knowledge or develop new ones. Speaking about EBP, one should mention the translation and analysis of data and their application in clinical decisions. In doing so, EBP aims to put into practice the most compelling evidence available. It is necessary to decide on the correct and effective treatment of patients, which should not stand still, but develop together with society. Usually, the evidence needed for this is based on the results of conducted clinical studies, but this goes beyond simple studies and includes clinical experience (Melnyk et al., 2017). In addition, the opinions, values, and preferences of patients and their families are essential to Evidence-Based Practice. While research is focused on generating new knowledge, EBP involves innovation in the healthcare system to find and implement the best guidelines in clinical practice. That said, it remains essential that when using EBP, sometimes the best evidence comes from opinion leaders and experts, even if there is no superior knowledge from research.
Understanding Quality Improvement
The quality of medical care is characterized by various aspects that affect the quality of services provided to patients. Quality improvement (QI) is not only driven by the healthcare system. Still, it is a collaborative and ongoing effort by everyone — health professionals, patients and families, researchers, payers, planners, and educators (Abou Hashish & Alsayed, 2020). That is necessary to develop the necessary changes that will lead to better patient outcomes (improved health), improved system performance (care), and better professional development. QI aims to use a systematic, data-driven approach to improve processes or outcomes. The principles and strategies used in QI have evolved from an organizational philosophy of total quality management and continuous quality improvement. Although quality can be subjective, QI in healthcare usually focuses on improving patient outcomes to improve patient safety and satisfaction (Abou Hashish & Alsayed, 2020). Thus, it is necessary to have a clear study result, which will allow the development of a plan to implement an intervention to improve the level of medical care.
Hospital Safety Assessment as Part of Evidence-Based Research
EBP combines the best available scientific evidence with clinical experience and patient values to improve outcomes. The process involves:
- Asking an appropriate clinical question.
- Finding the best evidence to answer it.
- Applying it in practice.
- Evaluating the evidence-based clinical results.
For example, many organizations review healthcare organizations for customer safety compliance. Leapfrog Hospital Safety Scores are awarded twice yearly to nearly 3,000 general acute care hospitals across the country (About the grade). The organization bases its analysis on evidence-based practice that translates the knowledge gained to improve medical performance. A lifelong approach to clinical practice integrates the systematic search, evaluation, and synthesis of relevant research, clinical experience, and patient preferences and values.
Quality of care is a rapidly growing segment of the healthcare industry that aims to improve the quality and efficiency of healthcare services patients receive. Quality of care exists to provide effective and efficient patient care in a healthcare setting. For a correct and suitable effective intervention, the following aspects of medical activity must be considered:
- patient orientation
- efficiency (Li et al., 2018)
In addition to Leapfrog, there is also the National Association for Healthcare Quality (NAHQ), which controls the quality and analyzes institutions for further application of the results in evidence-based practice. It is an organization that supports and provides resources to healthcare quality professionals (National Association). The primary role that the NAHQ performs is the certification of healthcare quality professionals to become CPHQ, a certified healthcare quality professional (National Association). NAHQ is committed to preparing a coordinated, competent workforce to lead and improve healthcare quality across the entire healthcare continuum.
Quality Improvement Programs
Quality indicators (QIs) are standardized, evidence-based measures of the quality of care that can be used with readily available administrative data on inpatient hospitals to measure and track clinical performance and outcomes. The QIO Program is one of the most extensive federal programs to improve the quality of health for Medicare recipients. It is an integral part of the US Department of Health and Human Services (HHS) National Quality Strategy for providing better care and health at less cost (Quality Improvement Organizations). By law, the mission of the QIO program is to improve the efficiency, cost-effectiveness, and quality of services provided to Medicare recipients (Quality Improvement Organizations). QIs are essential to improve patient care processes and outcomes in specific healthcare settings. Everyone — care providers, patients, researchers, payers — is a collaborative and relentless effort to make changes that will lead to better patient outcomes, system performance, and professionalism.
Relationship Between EBP and QI
Among other things, one of the most critical competencies of any medical worker is the implementation of EBP and QI. Even though EBP and QI can exist separately and are already independent and sufficient, they are still interconnected research areas. EBP is a basic and standard approach to problem-solving, the goal of which is patient safety and the provision of high-quality patient care (Abou Hashish & Alsayed, 2020). However, it has become clear over time that EBP needs additional support from QI, which acts as a contextual organizing factor for EBP adoption and can be used to validate results.
To have a significant impact on improving the quality of healthcare, the use of evidence-based practice (EPP) is necessary. Since EBPs are mainly based on empirical evidence, QI will allow them to be analyzed and validated practically. QI is described as a systematic, information-driven, change-driven activity to improve healthcare (Esposito-Smythers et al., 2021). Without EBP, health care participants are at risk of care deviations that can seriously affect patient outcomes, so clear case-by-case evidence helps mitigate these risks.
Aspects of the practical application of the principles of evidence-based medicine are primarily based on improving the quality of medical care. That implies the development of clinical guidelines for practitioners and the introduction of standardization systems in healthcare. Clinical guidelines for practitioners allow one to improve the work of a doctor concerning the following aspects:
- definition of the tasks facing the doctor;
- description of the disease (etiology, prevalence, clinical picture, and more);
- algorithms for diagnostic procedures (examination program, indications, contraindications for the appointment of diagnostic manipulations);
- treatment (tactics, description of specific drugs and therapeutic measures, criteria for effectiveness and cessation of baking);
- complications, prognosis, indications for hospitalization, dispensary observation, and more (Esposito-Smythers et al., 2021).
The two concepts of evidence-based medicine and quality improvement complement each other. While evidence-based medicine bases clinical decisions on evidence, quality improvement is ‘progressive’ (Abou Hashish & Alsayed, 2020). They are introducing evidence-based medicine into health systems practice and combating incentives in health care, whether non-financial, reputational, or financial. However, quality improvement becomes difficult to justify or measure and may not work without evidence.
EBP and QI support the core goals of improving patient satisfaction and the components of new knowledge, innovation, and improvement. EBP seeks and applies the best clinical data, often from research, to make patient care decisions, while QI uses systematic processes to improve patient outcomes. Evidence-Based Practice and Quality Improvement together are essential to improve healthcare delivery. Thus, the role of clinical trials and economic evaluation is to make complex clinical choices sound.
Although evidence-based medicine faces problems of practical implementation in medical organizations and is mainly based on empirical analysis, together with quality improvement, they share a common goal. The biggest challenge facing quality improvement advocates is how to engage clinicians and patients equally, making the concepts and their applications easier to understand. The interaction of these two concepts makes it possible to sufficiently direct practice to improve patient safety and satisfaction.
Abou Hashish, E. A., & Alsayed, S. (2020). Evidence-based practice and its relationship to quality improvement: A cross-sectional study among Egyptian nurses. The Open Nursing Journal, 14(1), 254–262. Web.
About the grade. Home. (n.d.). Web.
Esposito-Smythers, C., Defayette, A. B., Whitmyre, E., Steinberg, P., Goldston, D. B., & Asarnow, J. R. (2021). A community call to action: Use of quality improvement strategies to address youth suicides. Evidence-Based Practice in Child and Adolescent Mental Health, 6(3), 328–342. Web.
Li, S.-A., Jeffs, L., Barwick, M., & Stevens, B. (2018). Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: A systematic integrative review. Systematic Reviews, 7(1). Web.
Melnyk, B. M., Gallagher-Ford, L., Zellefrow, C., Tucker, S., Thomas, B., Sinnott, L. T., & Tan, A. (2017). The first U.S. 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. Web.
National Association for Healthcare Quality. NAHQ. (n.d.). Web.
Quality Improvement Organizations. CMS. (n.d.). Web.
Quality indicators. AHRQ. (n.d.). Web.
Tebala, G. D. (2018). The emperor’s new clothes: A critical appraisal of evidence-based medicine. International Journal of Medical Sciences, 15(12), 1397–1405. Web.