Integrating Evidence into RT Practice: An Important Focus for the Profession Chapter 15 HPR 453

Evidence-based Medicine Introduced in early 1990s Basing healthcare on empirical evidence fits ell with healthcare trends Reduce risk and harm to patients Reduce unnecessary costs Consistently provide outcomes valued by stakeholders (patients/consumers, payers, employers, regulatory agencies and policy makers National healthcare expenditures grew 7% in 2005 to $2 trillion

Evidence-based care reduces variation in care and unnecessary costs Used by healthcare disciplines to demonstrate that they achieve consistent outcomes valued by stakeholders For purposes of this Chapter, the term Recreational Therapy is defined as treatment services and interventions provided in a clinical setting and are designed to restore, remediate, or rehabilitate patients in order to improve functioning and independence in life activities.

The Changing Healthcare Paradigm 1999 Institute of Medicine Report As many as 44,000 and up to 98,000 people die in hospitals each year due to preventable medical errors Total cost of the errors = between $17billion and $29 billion taking into account additional care necessitated by the errors, lost income and productivity, and disability Generated public awareness and response focusing on safety, risk mgmt, cost effective care, and evidence-based healthcare Pressure for accountability has increased significantly

IOM issued a report in 2001 recommending the healthcare system should better meet healthcare needs and be: (pg 251) Safe Effective Patient-centered Timely Efficient Equitable

EB RT practice is based upon the judicious use of the current best evidence to make effective clinical decisions about the treatment of patients to reach outcomes valued by stakeholders. EBP is consistent with professional standards of practice. EBP encompasses both individualized treatment plans and treatment delivered by the use of clinical practice guidelines or clinical pathways. West (2006)

A fundamental assumption of EBM is that practitioners whose practice is based upon an understanding of evidence from applied healthcare research will provide superior patient care compared with practitioners who rely on understanding of basic mechanisms and their own clinical experience. Haynes (2002) If not EBP, Recreational Therapists provide tx based on customary practice? Current trend? Opinion of a colleague? Practitioner desire to use an intervention?

How effective is this. How much is it provided by stakeholders How effective is this? How much is it provided by stakeholders? How cost effective? Focus should be on outcomes in financially strained healthcare system if RT is to gain understanding and support of stakeholders “through EB service delivery, each practitioner should feel confident that she or he is providing the best possible care that is known to produce the most desirable, intended, and meaningful outcomes” Stumbo (2003a)

Steps to Finding Evidence for Practice Formulate a clear clinical question from a patient’s problem Search databases for relevant clinical evidence Appraise the evidence Implement and use findings in practice Evaluate the impact of change in practice

Implementing EB RT Practice Assess Plan Implement Evaluate