The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
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The Center for Evidence-based Policy at Oregon Health & Science University is a national leader in evidence-based decision making and policy design.
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We publish The Milbank Quarterly, as well as reports and issues briefs on topics important to population health.
June 2009 (Volume 87)
June 2009 | Jason M. Satterfield, Bonnie Spring, Ross C. Brownson, Edward J. Mullen, Robin P. Newhouse, Barbara Walker
Context: This article describes the historical context and current developments in evidence-based practice (EBP) for medicine, nursing, psychology, social work, and public health, as well as the evolution of the seminal “three circles” model of evidence-based medicine, highlighting changes in EBP content, processes, and philosophies across disciplines.
Methods: The core issues and challenges in EBP are identified by comparing and contrasting EBP models across various health disciplines. Then a unified, transdisciplinary EBP model is presented, drawing on the strengths and compensating for the weaknesses of each discipline.
Findings: Common challenges across disciplines include (1) how “evidence” should be defined and comparatively weighted; (2) how and when the patient’s and/or other contextual factors should enter the clinical decision-making process; (3) the definition and role of the “expert”; and (4) what other variables should be considered when selecting an evidence-based practice, such as age, social class, community resources, and local expertise.
Conclusions: A unified, transdisciplinary EBP model would address historical shortcomings by redefining the contents of each model circle, clarifying the practitioner’s expertise and competencies, emphasizing shared decision making, and adding both environmental and organizational contexts. Implications for academia, practice, and policy also are discussed.
Author(s): Jason M. Satterfield; Bonnie Spring; Ross C. Brownson; Edward J. Mullen; Robin P. Newhouse; Barbara Walker
Keywords: evidence-based practice; clinical decision making; transdisciplinary practice
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Volume 87, Issue 2 (pages 368–390)
Published in 2009
How Do You Modernize a Health Service? A Realist Evaluation of Whole-scale Transformation in London
Comparative Effectiveness Research and Evidence-based Health Policy: Experience from Four Countries