Evidence-based practice versus quality healthcare –which is the egg and which is the chicken?
In recent times, the term ‘evidence-based’ has become more common in our day-to-day conversations – quite often as a way of qualifying interventions as up-to-date. Commonly, we hear of the terms evidence-based medicine, evidence-based practice, evidence-based policy, evidence-based education and evidence-based social work amongst others.
Recently, the use of the term ‘quality health care’ has gained momentum especially while reflecting on healthcare in limited resource settings.
Evidence and quality – which is the egg and which is the chicken?
What is evidence-based medicine/healthcare?
David Sackett and colleagues define evidence-based medicine (EBM) as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
What is quality healthcare?
Avedis Donabedian acknowledged the definition of quality health care as being elusive – It can be defined as almost anything that one wishes it to be. Whichever definition one adopts, quality health care is a reflection of values and goals current in the medical care system and in the larger society of which it is part. In other words, quality is contextual. Donabedian’s review sensibly concludes that to measure or assess quality in healthcare, the focus should be on the structure, process and outcome.
Does evidence inform quality or does quality inform evidence?
Evidence-based practice and quality healthcare both converge on patient outcomes. For practice to be evidence-based, it must take into consideration all the components of the EBM-Triad: clinical expertise, best available evidence and patient values and expectations. On the other hand, for practice to be quality practice, it must incorporate the best available evidence and best expertise into the structures and processes that determine outcomes. Involvement of the patients in setting quality standards that inform and assess quality is paramount. To ensure efficacy, Gillam and Siriwardena emphasise on the use of sound evidence to inform quality improvement initiatives. Raven and colleagues brilliantly outlined the methodology and tools for quality improvement in maternal and newborn health care in a review paper(Raven).
In conclusion, evidence-based health care and quality healthcare are mutually dependent and complementary. One feeds into the other in a continuous and cyclical manner. Importantly, both are most relevant and have maximum impact when they are context specific – locally generated evidence, locally relevant expertise and standards to inform local quality. CMNH is currently leading quality improvement work in low and middle income countries using a standards-based-audit approach. CMNH is also at the forefront of innovative context-relevant research on quality improvement in maternal and newborn health in the same countries. The overall objective is to empower the countries towards a sustained reduction in maternal and neonatal morbidity and mortality.
About the author:
Dr Francis Githae Muriithi is an Obstetrician & Gynaecologist, Senior Clinical Research Associate at CMNH, Liverpool School of Tropical Medicine and an Oxford Academic Health Science Network (Oxford AHSN) Fellow in Evidence-Based Health Care.