Introduction
The case “Constraints of the ACA on Evidence-Based Medicine” in the Health policy analysis discusses the challenges and opportunities of implementing evidence-based medicine (EBM) in the context of the ACA. According to the case, the Affordable Care Act (ACA) has introduced several new constraints on EBM. They include the increasing focus on cost containment, the shift towards value-based payment models, and the use of electronic health records (EHRs) (McLaughlin & McLaughlin, 2014). These constraints can impact how evidence is used to inform clinical practice, potentially undermining the principles of EBM. It will be important for healthcare providers and policymakers to consider these constraints and to identify strategies to ensure that EBM is upheld in the changing healthcare landscape.
Discussion
Before describing the method, it is necessary to understand evidence-based analysis and its primary use. Evidence-based practice (EBP) is a methodical approach to solving problems in the delivery of healthcare that enhances the quality and population health outcomes, lowers costs, and gives clinicians the freedom to engage in their roles fully (Gallagher‐Ford et al., 2020). Evidence-based medicine (EBM) transforms clinical issues into questions, which are then methodically found, evaluated, and used as the foundation for therapeutic choices (Vere & Gibson, 2018). The intercultural competence clinical proof from organized research is combined with a person’s knowledge to practice evidence-based medicine. The approach to evidence-based medicine consists of five phases. The five phases in the process of evidence-based analysis include formulation of clear clinical questions, methodical gathering of the strongest evidence, evaluating that evidence, applying that evidence, and performance evaluation.
Formulating comprehensible clinical questions is the initial stage of using the evidence-based analysis method. A question is developed in this stage of the procedure. The issue in a medical environment is typically one of diagnosis, prognosis, treatment, iatrogenic injury, care quality, or health economics. Four steps must be taken while creating a question as part of the procedure. Discovering pertinent research is one strategy utilized when creating a query. Finding places where people need to know more is another strategy when formulating a question.
Connecting scientific research information to practice is the third strategy that aids in developing a query. The last strategy for creating a question is concentrating on the research strategy. This stage of the evidence-based analysis process involves gathering and classifying research. Search plans and results for the query or each of the questions created in step one are one method utilized to do this. Reports should provide inclusion and exclusion criteria as part of the second stage.
The following are some examples of criteria: age, setting, sample size, acceptable dropout rate, year range, English language, databases examined, search phrases, and list of articles. Critically analyzing the evidence is the third phase in the evidence-based analysis process. The validity and relevance of research to the topic posed in step one are assessed at this stage of the evidence-based analysis process. A checklist that may be used to assess the research’s applicability and validity is provided in this stage.
The checklist asks whether implementing the studied intervention or procedure would lead to better outcomes for the patients, clients, or population group. It includes whether the authors looked at a result or subject that patients, clients, or members of the population would find interesting. On the contrary, whether the intervention or procedure is feasible, whether the research question was clearly stated, and whether the choice of study subjects was appropriate.
Applying the evidence discovered in step two and confirmed in step three is the fourth stage in the evidence-based analysis process. One strategy employed in this part of the evidence-based analysis process is synthesizing the evidence in an overview table and evidence summary. Applying the evidence to patient treatment directly and developing protocols and recommendations are two other strategies employed in this stage of the evidence-based analysis process. Evaluating the approach’s effectiveness in step four is the final stage in the evidence-based analysis process.
The strategy utilized in this process stage is creating a conclusion statement and rating the quality of the supporting evidence. The explanation of the grades of the supporting evidence is another component of this process stage. When it comes to evidence-based medical policy, there are many different participants. Patients, providers, and administrators are some of the participants. The patients and the providers are the two main participants. The suppliers, however, stand out as the most crucial factor among the two of them. In a healthcare context, providers offer patients care, and nurses are the most crucial providers. The focus on evidence-based practice in healthcare delivery has raised the bar for nurses (Graystone, 2019). They are now expected to use research results to guide their clinical judgments, nursing interventions, and client interactions in a dynamic and more complicated healthcare environment.
The “Levels of Evidence” refer to a hierarchy of evidence used to determine scientific research’s strength and reliability. They are often used to guide clinical decision-making and to evaluate the quality of evidence that supports various interventions and treatments (Vere & Gibson, 2018). A pyramidal graphical depiction of the degree of evidence conveys rankings, and the evidence pyramid can have between four and ten levels (McLaughlin & McLaughlin, 2014). Since they are systematic research combining results from several investigations, the summit of the evidence pyramid reflects the most trustworthy studies. Randomized controlled trials, sometimes referred to be the gold standard, are located in the middle of the pyramid.
The least trustworthy research, individual viewpoints, and case reports are located at the base of the pyramid since they represent the opinions of specialists. The Patient-Centered Outcomes Research Institute was established to provide financial support for generating high-quality research that would empower patients and clinicians to make knowledgeable, individualized healthcare decisions (Mason et al., 2019). It is one of the examples of research that can be considered less trustworthy.
Some revised tenets emphasize increasing access to affordable health care and coverage, improving the availability of evidence-based preventive services, and eliminating disparities that restrict health care availability and equitable delivery. It bolsters the public health infrastructure to address social determinants of health, prioritize and accelerate investments in biomedical research, and develop a diverse, culturally competent health and healthcare workforce (Warner et al.,2020). However, one of the restrictions states that the Secretary may only consider the evidence and results from research done under section 1181 to decide regarding coverage, which may be compared to the degree of evidence at the top of the pyramid, which is backed by thorough studies (McLaughlin & McLaughlin, 2014). Another restriction is that the Secretary is prohibited from utilizing data or conclusions from comparative clinical efficacy research (McLaughlin & McLaughlin, 2014). Specifically, it implies the research that falls within the middle tier of the evidence pyramid and is thus supported by randomized controlled trials.
Conclusion
Overall, evidence-based practice addresses healthcare issues that improve population health outcomes and quality, reduce costs, and fully allow clinicians to perform their duties (Vere & Gibson, 2018). The best external clinical evidence from systematic research is paired with an individual’s understanding to perform evidence-based medicine. The question on the checklist is if putting the researched intervention or method into practice would improve outcomes for the patients, clients, or demographic group. Some tactics at this level include producing procedures and recommendations and immediately applying the data to patient therapy. The process of evidence-based analysis culminates in assessing the success of the method.
References
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Graystone, R. (2019). 2019 Magnet® Application Manual raises the bar for nursing excellence. American Nurse. Web.
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McLaughlin, C. P. & McLaughlin, C. D. (2014). Health policy analysis. Jones & Bartlett Publishers.
Vere, J., & Gibson, B. (2018). Evidence‐based medicine as science. Journal of Evaluation in Clinical Practice, 25(6), 997–1002. Web.
Warner, J. J., Benjamin, I. J., Churchwell, K., Firestone, G., Gardner, T. J., Johnson, J. C.,… & American Heart Association Advocacy Coordinating Committee. (2020). Advancing healthcare reform: The American Heart Association’s 2020 statement of principles for adequate, accessible, and affordable health care: a presidential advisory from the American Heart Association. Circulation, 141(10), e601-e614. Web.