Practice-Based Evidence
Marisa A. Colston, PhD, ATC
University of Tennessee at Chattanooga
Do the majority of research articles you read significantly contribute to your daily clinical decision making with individual patients? The statistics on the number of published articles in health care are astounding. If you are overwhelmed by the amount of evidence, the good news is that most of it can be ignored. The reported number of articles to find one that is valid and relevant is 400, but to find these gems, we need to use the evidence more critically.
Profound, transformative changes are making healthcare more accessible, improving the quality and efficacy of patient treatment, and revolutionizing the way valuable information is collected, exchanged and applied. Healthcare is moving toward a practice-based evidence, decision-making model. Employers, consumers, payers and providers are demanding credible and actionable data. Athletic trainers, as a whole, are slow to come on board with this movement.
Continuous quality Improvement is a strategy used by the business community to identify problems, implement and monitor corrective action and document response effectiveness. An example would be whether health services are achieving patients’ desired functional outcomes. This requires an ongoing cycle of collecting data and using it to make decisions to gradually improve processes. Many athletic trainers collect data in routine daily clinical care, however, few know how to use the data retrospectively and prospectively to improve outcomes. Even less rare is pooling the data with other athletic training programs in similar settings, to apply the data to make clinical decisions for individual patients.
The gap between availability of evidence and application in care delivery contributes to poor health outcomes. Addressing this requires a mindset of collaboration rather than competition as it relates to sharing data. With the 2018 changes in the Common Rule allowing for the use of a single Institutional Review Board (IRB) for multi-site studies conducing the same protocol, the mechanism is now in place to start pooling data. Data aggregation (high schools, colleges, etc.) improves clinical decision making by improving the quality of care, minimizing errors, early detection of adverse events, improved efficiency and improved patient satisfaction. Start the conversation with colleagues. There are electronic injury documentation systems that are free (e.g., AT-PBRN and Dragonfly) that can be used to pool data in an efficient and HIPAA-compliant manner.