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

2. 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

3. 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.

4. 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

5. 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

6. 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)

7. 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?

8. 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)

9. 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

10. Implementing EB RT Practice
Assess
Plan
Implement
Evaluate