Evidence-Based Practice: The Coin of the Realm in CSD Our discipline has always been committed to identifying best practices and developing innovative approaches that work. Practitioners in both professions have always been charged with making a clinically significant difference and achieving positive outcomes. So what’s changing? We hear in the daily menu of alphabet-soup acronyms related to health care ... From the President
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From the President  |   June 01, 2011
Evidence-Based Practice: The Coin of the Realm in CSD
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Research Issues, Methods & Evidence-Based Practice / From the President
From the President   |   June 01, 2011
Evidence-Based Practice: The Coin of the Realm in CSD
The ASHA Leader, June 2011, Vol. 16, 7. doi:10.1044/leader.FTP.16072011.7
The ASHA Leader, June 2011, Vol. 16, 7. doi:10.1044/leader.FTP.16072011.7
Our discipline has always been committed to identifying best practices and developing innovative approaches that work. Practitioners in both professions have always been charged with making a clinically significant difference and achieving positive outcomes. So what’s changing?
We hear in the daily menu of alphabet-soup acronyms related to health care reform that demonstrating clinically meaningful outcomes is no longer optional. There are ACOs (accountable care organizations) and EBP (evidence-based practice), which will eventually form the basis for P4P (pay for performance) via the PQRS (Physician Quality Reporting System). You have probably read previously in The ASHA Leader that the Centers for Medicare and Medicaid Services (CMS) has endorsed eight functional communication measures (FCMs) from ASHA’s National Outcomes Measurement System (NOMS) as PQRS-approved outcome measures. It is likely that measuring and reporting outcomes soon will be mandated for all reimbursable services.
We must be familiar with today’s health care jargon, but more importantly, be able to “walk the walk” with other providers seeking effective, state-of-the-art interventions that make a difference and enhance quality of life. Evidence-based approaches to practice enable clinicians to benefit from the relevant scientific evidence to address optimally clinical challenges and decision-making.
According to ASHA, the goal of EBP is integration of clinical expertise, best current evidence, and client values to provide high-quality services reflecting the interests, values, needs, and choices of those we serve. The EBP approach helps assure administrators, payers, and consumers of highest-quality care. EBP is not, however, about identifying the one best approach—it is about deciding which among the many acceptable options is likely to work best for a particular individual.
Ultimately, the goal of EBP is to provide optimal clinical service to an individual. Because EBP is a dynamic integration of ever-evolving clinical expertise, external evidence, and client values and perspectives, it is essential that practitioners stay apprised of recent advances but adapt the information to meet the needs of the individual receiving services in the best way possible.
A growing body of Evidence-Based Guidelines and Evidence-Based Systematic Reviews (EBSRs) can be accessed easily from the ASHA Compendium, which provides an efficient way for busy practitioners to access evidence-based information about assessing and treating specific communication disorders. Some of these resources have been generated by ASHA and some by other organizations, but all guidelines and systematic reviews contained in the ASHA Compendium and in ASHA’s new Evidence Maps have been vetted by ASHA’s National Center for Evidence-Based Practice and meet quality standards.
The first step in applying evidence to a clinical decision is framing the specific question. A widely used approach is known as PICO (Population, Intervention, Comparison, and Outcome). Addressing all four of these clinical questions helps to ensure that the evidence obtained will be relevant to the particular circumstances of the search. For example, the PICO model may focus on:
  • Population: Stroke patients with aphasia

  • Intervention: Early initiation of “X” treatment

  • Comparison: Treatment initiated early (within three months post-onset) versus later (after six months post-onset)

  • Outcome: Functional communication abilities

The first question, then, could be written “Are patients with aphasia who receive speech-language treatment shortly after their stroke more or less likely to achieve improved functional communication abilities than those who receive such treatments later?” The second step is finding the evidence. Ideally, relevant EBP guidelines will already exist. If not, the clinician can seek out other evidence, from systematic reviews or individual studies, to help inform the clinical decision.
The third step in applying EBP is assessing the evidence, not only for quality but also for how well it addresses the particular circumstances of the individual being treated. Not everyone feels well-prepared to judge the quality of evidence; one of the benefits of consulting the ASHA Compendium and Evidence Maps is that those resources have already been vetted based on pre-established criteria. The fourth step is making clinical decisions by integrating one’s clinical expertise, the client’s perspective, and the available scientific evidence.
I encourage each of you to search “evidence-based practice” at ASHA’s website. You will likely be impressed by the depth and breadth of guidance, references, and direction on EBP. Members’ pleas have been for more evidence, systematic reviews, and outcomes research to inform their practice. In 2005, ASHA established its National Center for Evidence-Based Practice in Communication Disorders (N-CEP), which has been steadily developing tools—like the Evidence Maps and Compendium—and generating EBSRs to help audiologists and speech-language pathologists more easily incorporate external evidence, expert opinion, and client perspectives into their decision-making without having to spend an inordinate amount of time locating and vetting this information. Sometimes I feel like a genie with such a treasure-trove of resources at my fingertips. Visit the ASHA website for just-in-time information that I’m sure you will find very helpful!
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FROM THIS ISSUE
June 2011
Volume 16, Issue 7