This post was edited by Mike Battista, Director of Science and Research at Creyos (formerly Cambridge Brain Sciences).
In today's changing medical landscape, cognitive health care best practices are evolving every day. Evidence-based practice (EBP) helps providers use the most up-to-date research to improve patient outcomes.
For example, while the use of restraints used to be standard for dementia patients, modern research has found that this practice is quite harmful to patients. Integrating EBP into the clinical experience interrupts the implementation of outdated and ineffective practices.
In this article, we will explore:
- The definition and examples of evidence-based practice
- Characteristics of evidence-based medicine
- The value of evidence-based assessment tools for brain health
- How clinicians can implement EBP into cognitive health care
By staying informed with evidence from scientific research, primary care providers, nurse practitioners, neurologists, and mental health providers can offer the highest quality of patient care.
What is Evidence-Based Practice?
Evidence-based practice (EBP) is a John-Hopkins established care model that prioritizes using the best available evidence for clinical decision making and treatment strategies.
This approach makes use of:
- Credible, valid, and reliable scientific research
- Clinical expertise
- Patient preferences and values
Upholding a patient-centered approach while implementing up-to-date research evidence helps healthcare providers and patients make the most informed care decisions possible.
Here are a few examples of how evidence-based interventions may present slightly differently depending on the healthcare context:
- Nursing: Taking non-invasive medical approaches where possible, involving family in discussions where appropriate, and communicating patient preferences with fellow members of the patients’ health team.
- Brain health: Using scientifically validated, state of the art assessment tools in clinical practice and conducting ongoing evaluations to track changes in neurological and cognitive health over time.
- Mental health: Listening to individual patients’ unique experiences and following data-driven practices to provide detailed reports on symptoms and targeted treatments.
Some practices that don’t actively integrate EBP include:
- Relying on personal experience without consulting research evidence
- Acting solely on intuition rather than established protocols
- Working with single-source evidence
- Implementing unvalidated therapies
- Taking a one-size-fits-all approach
- Ignoring patient preferences
The value of evidence-based programs has been widely recognized across many fields in addition to healthcare programs. According to the National Association of Social Workers, education, child welfare, and criminal justice organizations are now also integrating EBP into their practices.
However, in one study, it was found that although roughly 87% of nurses are familiar with evidence-based practice, only 47% had incorporated it into their clinical practice. Many of these nurses acknowledged that while EBP is valuable, substantial workloads and lack of training made them often default to older ways of doing things.
Examples of Evidence-Based Practice
Here are a few examples of evidence-based practices that clinicians, nurses, neurologists, and mental health professionals can implement:
Nursing Examples
Nurses have an extremely active role in patient care, and can incorporate evidence-based practices such as:
- Prioritizing empathy and active listening in the nursing practice. Along with standard care duties, nurses (and other healthcare providers) often end up serving as patient advocates. Naturally, positive nurse-patient relationships have been found to be linked with better patient outcomes.
- Applying strategies that meet individual patient needs. For instance, identifying individuals’ fall risks and offering support for exercises can protect elderly patients in both residential and homecare settings.
- Seeking additional education where available. In one study on pain management, only one quarter of nurses were found to have good pain management practices. In order to provide quality pain management education for patients, it is essential that nurses are provided with the necessary tools to have a strong grasp on the information themselves.
Brain Health Examples
With an estimated 10% of Americans over 65 suffering from dementia and roughly 22% experiencing mild cognitive impairment, enhancing the quality of cognitive care is more important than ever.
Here are three ways to implement EBP in the field of brain health:
- Educate dementia patients and caregivers on evidence-based dementia prevention strategies. One study suggested that roughly one third of Alzheimer’s disease cases could tie back to modifiable risk factors such as lower education level, midlife hypertension, smoking, and depression.
- Use trusted assessment tools to regularly test cognitive function, especially in older adults. Collecting this data can help monitor cognitive performance and identify need for preventive strategies—as well as give patients key insight into the state of their brain health.
- Learn more about individual patient values and beliefs. Some studies have found that consistent religious and spiritual activities can support cognitive health in older adults who are already religious.
Mental Health Examples
As of 2022, nearly 20% of Americans are living with mental illness, with nearly 5% living with mental disorders that are classified as severe.
Including evidence-based interventions in mental health services can look like:
- Dedicating time to interpersonal relationship building. In one study, it was found that a physician’s knowledge of a patient’s illness and emotional state was positively linked to symptom resolution.
- Confirming the currently recommended therapeutic models for a patient’s diagnoses. For example, while cognitive behavioral therapy (CBT) is currently the go-to therapy for most disorders, it is not a one-size-fits-all solution. Patients with borderline personality disorder (BPD), for example, may benefit from dialectical behavioral therapy (DBT).
- Keeping up to date with the latest research on medications. On average, the FDA approves 53 new medications per year. Looking out for new medications, as well as fresh data on the effectiveness of existing medications, can help patients who have struggled to find the right fit.
- Recognizing when models like assertive community treatment (ACT) are necessary. Compared to standard case management treatments, the ACT model has led to a 37% reduction in homelessness among patients with severe psychiatric symptoms. Familiarity with these models can help healthcare professionals serve the most vulnerable members of the local community.
Why EBP is Important: 4 Benefits of Evidence-Based Practice
Evidence-based practices require a combination of patient-centered communication and objective scientific research findings. Complementing subjective assessment measures with objective tools gathers the most comprehensive evidence to form an effective treatment plan.
Clinicians can improve the effectiveness of their evidence-based care by:
- Using standardized, validated questionnaires and assessment tools
- Using relationship-building strategies during interviews with patients
- Running labs to gather biomarker insights, when possible
- Connecting with colleagues for additional perspectives
- Reading through systematic reviews and research studies
These strategies provide additional evidence that can help:
- Build trust with patients to provide a better patient experience. The emotional aspect of care may have a major impact on patient outcomes. Prioritizing positive patient-provider relationships naturally incorporates patient-centeredness into a clinician’s daily practice.
- Support confident diagnosis and decision making. The research that goes into evidence-based medicine keeps providers up-to-date with current best practices. Should patients have questions about their treatment plan, clinicians can also share this research.
- Encourage reassessment. Regularly reviewing the state of a patient’s physical, mental, and cognitive health ensures that their treatment plans match their current needs. This is especially important for patients with diseases like rapidly progressive dementia (RPD), whose needs will change quickly over a short period.
- Improve workflow across the clinic. For clinicians who are beginning to grow their medical practice, integrating EBP can help streamline this process. Substantial workload is a major cause of burnout among healthcare workers. Building a foundation of practice based on current evidence can make a difference in quality of care by enhancing efficiency and reducing administrative strain. For example, modern computerized testing methods may not only provide higher-quality evidence than traditional pen-and-paper tools, but they are more efficient to administer and interpret.
A positive clinical experience allows patients to access the treatment strategies they require and improve their overall quality of life.
Steps for Running Evidence-Based Programs
Evidence-based programs include a few key steps:
1. Start With a Patient-Centered Approach
Patient-centered care prioritizes patients’ individual needs and goals, and includes them as active members in their own care plans. Depending on the individual patient, family members may also be a part of the care team.
Patient-centeredness ensures that treatment options will keep in mind patients’:
- Emotional and social needs
- Spiritual and cultural beliefs
- Financial capacity
A key characteristic of evidence-based practices is clear and open communication. Learning patient preferences and values builds trust and helps clinicians gather useful information about the individuals they’re working with.
Imagine a chronic pain patient keeps missing their appointments. An open discussion might reveal that their fluctuating energy and pain levels are a barrier to travel. With this knowledge, offering virtual primary care could be what gets the patient the care they need.
2. Seek Out Relevant Evidence, Research, and Clinical Experience
A major requirement of evidence-based medicine is right there in the name: evidence. Integrating EBP into a clinical practice means regularly reviewing the latest literature on the treatments and practices that are most recent, relevant, and effective.
This can be done by:
- Finding scientifically validated assessment tools for patients
- Reviewing research findings with colleagues and mentors
- Attending professional development events
- Looking through accredited medical journals
One survey showed that 15% of the time, doctors were uncertain about ordering diagnostic tests. Along with this, 8% of the time they were uncertain about interpreting the results. Conducting additional research about which tests are the most medically necessary can increase the effectiveness of treatment, and save money on unnecessary labs.
3. Evaluate the Evidence
Not all evidence is created equal, and understanding how reliable each source is can help guide decision-making. The Oxford Center for Evidence-Based Medicine (OCEBM)’s 2011 Levels of Evidence table guides providers towards how to evaluate evidence in real time.
This heuristic table is organized based on seven questions:
- How common is the problem?
- Is this diagnostic or monitoring tool accurate?
- What will happen if we do not add a new therapy?
- Does this intervention help?
- What are the common harms of this treatment?
- What are the rare harms of this treatment?
- Is this specific early detection test worthwhile?
Using a systematic review is always the top choice (versus an individual study) if it is available. If it is not, this chart helps clinicians determine the next best choice of evidence without dedicating additional time to extensive research that could be spent with patients.
4. Apply the Evidence to your Treatment Plan, Clinical Practice, and Decision Making
When integrating EBP into a clinical practice, communication with the medical team is essential. Informing staff about any shifts in guidelines can help keep treatments consistent across the practice and make sure patients experience the best quality care.
Both patients and practitioners might initially be resistant to new evidence that is presented if it is contrary to current practices. The Semmelweis reflex is the reflex-like tendency to reject new evidence that contradicts the current established norms. The stronger the evidence for the effectiveness of new strategies, the smoother it will be to get people on board.
5. Measure the Outcomes Through Retesting and Make Any Adjustments
The best available evidence is often the most recent evidence. This is especially true in the case of neurological and psychological health care, patients’ cognitive and emotional experience can vary greatly over time.
Regularly testing and retesting patients helps gather information about the effectiveness of treatments—both for individual patients and at a group level—and highlights if a pivot is necessary.
Cognitive Health Tools for Evidence-Based Practice
There are several different types of tools that can support evidence-based practice in cognitive health care, including:
- Online cognitive assessments. Creyos' scientifically backed tasks only take 2 to 3 minutes each to measure patients’ short term memory, reasoning, concentration, and verbal ability. These tasks are more engaging than pen-and-paper worksheets, and compile data into detailed reports.
- Telehealth equipment with integrated video and audio capabilities, such as mobile apps to provide virtual health care. This equipment may also include secure tablets for storing patient data, or wearable healthcare equipment for monitoring patient vital signs at home.
- Secure record-keeping and reporting tools. 38.2% of doctors reported difficulty accessing medical records as a reason for unnecessary treatment. Having tools that collect and store patient data can help improve workflow for providers.
Creyos’ healthcare software offers data-driven insights into patients’ cognitive and mental health. Our cognitive assessments can easily be incorporated into patient intakes, allowing you to gather ongoing information about the state of patients’ cognitive function.
Patient Care and Evidence-Based Interventions
Evidence-based practice helps clinics stay up to date with the latest treatments and best practices that align with findings of current research studies. Furthermore, EBP provides patients with the best available evidence to help them be engaged in their own health care.
With accurate research, clinical expertise, and extra consideration for patient preferences, evidence-based programs give both patients and providers the tools they need to improve health outcomes.