Evidence-based Prectices Procedural Guidelines - September
2007
I. Purpose of Document
- Develop a shared vision for the development and implementation
of Evidence-Based Practices (EBPs)
- Articulate principles to guide our work
- Commit to continued quality improvement and decision making
based on data
- Guide the OAMHS concerning the place of EBPs in the delivery
of services
II. National Perspective
In 2001, the Institute of Medicine
released a report, "Crossing
the Quality Chasm: A New Health System for the 21st Century",
that called for building a stronger health system over the coming
decade that is capable of providing state-of-the-art health
care to all Americans.
The report included the following statements regarding healthcare
in the United States:
- "Evidence based decision making: Patients should
receive care based on the best available scientific knowledge.
Care should not vary illogically from clinician to clinician
or from place to place."
- "Organizations…can improve their performance
only by incorporating care process and outcome measures into
their daily work…to understand the degree to which performance
is consistent with best practices, and the extent to which patients
are being helped."
- "Applying Evidence to Health Care Delivery: In
the current health care system… about 17 years is required
for new knowledge generated by randomized controlled trials
to be incorporated into practice, and even then application
is highly uneven (Balas and Boren, 2000)."
III. Guiding Principles
The Maine State Health Plan, defining
health broadly to include both physical and behavioral health,
informs these guiding principles.
- Broad Definition of Health
We are defining health as a state of physical, mental and social
well-being and safety across the lifespan. Health promotion
includes medical care as well as other factors that influence
wellness such as healthy lifestyles, prevention, secure social
relationships and adequate income.
- Health Across the Lifespan
Quality services must be age appropriate.
- Wide Spectrum of Interventions
We support the use of a wide spectrum of effective interventions
that include the promotion of healthy communities, prevention
strategies, early intervention and quality services.
- Person-centeredness
Person-centeredness means acknowledging individual differences
and characteristics, including different biology, culture,
beliefs, values, preferences, history, abilities and interest.
- Partnership Building
Ongoing meaningful multi-stakeholder participation is essential
to the implementation of EBPs
- Decision-Making Based on Data
Meaningful data and objective analyses of population-based needs
are necessary for effective program planning, decision-making
and quality assurance.
- Outcome Oriented
Quality service design and delivery are based on measurable
outcomes that are meaningful to a variety of stakeholders
and reflect the vision and goals of the Office of Adult Mental
Health Services as well as the Department as a whole. Outcomes
ultimately will promote recovery, health, wellness and community
integration in relation to individuals' self-determined goals.
- Quality Services
Our goal is that every individual will receive services that
are evidence-based and effective
- Informed Choice
Every individual is entitled to receive information on risks
and benefits necessary to make an informed choice
- Respect
The nature and quality of the relationship between consumer
and provider is critical to quality services
- Individualized Service
Quality service is individualized: matching services to the
needs, strengths, preferences and values of the recipient.
It is the right service for the right person at the right
time.
- Cultural Competence
Quality services must be culturally competent
IV. The Office of Adult Mental Health Services' Statement of
Intent
The mission of Maine's Department of Health and Human Services
(DHHS) is to provide integrated health and human services to
the people of Maine to assist individuals in meeting their needs,
while respecting the rights and preferences of the individual
and family, within available resources.
In keeping with that mission, OAMHS is committed to providing
services that are based on the best evidence available; and
that improve outcomes and quality of life for Maine people.
This is part of a system-wide commitment to continuous quality
improvement and decision making based on individual, system
and service outcomes. The outcomes to be measured will be defined
in collaboration with multiple stakeholders. We will continually
develop the system of care, and change and realign existing
services to appropriately support all levels of Evidence Based
Practices.
V. Definitions
- Evidence-Based Practices
Evidence-Based Practices is an umbrella term defining a range
of levels of evidence or research- supported practices. The
levels of evidence span the spectrum from extensive to minimal.
(Based on Turning Knowledge Into Practice: A Manual for Behavioral
Health Administrators and Practitioners About Understanding
and Implementing Evidence-Based Practices, Fall 2003)
Evidence-Based
Practices (EBPs)
Evidence-Based Practice is the integration of best research
evidence with clinical expertise and patient values (Institute
of Medicine, 2001), or clinical or administrative interventions/
practices for which there is consistent scientific evidence
showing that they improve client outcomes (Drake, et al. 2001).
The
term Evidence-Based Practices encompasses three categories listed
below that reflect practices with varying levels of evidence:
practices based on scientific evidence; promising practices;
and emerging practices. All levels of Evidence-Based Practices
must include to varying degrees the following:
• They are accepted practice for a specific group and problem
• There is literature in peer reviewed journals providing
data regarding efficacy
• Implementation guidelines exist
• They have a sound theoretical basis
1. Practices Based on Scientific
(see definition below) Evidence
Practices Based on Scientific Evidence are clearly defined practices
that have been shown to adhere to the highest level of scientific
evidence based on rigorous research, to improve client outcomes
or population or systemic goals. For health care, these practices
include those endorsed nationally as quality standards by
the Agency for Health Care Research and Quality and the National
Quality Forum
2. Promising Practices
Promising practices are practices that have considerable evidence
or expert consensus and which show promise in improving client
outcomes, but which are not yet proven by the highest or strongest
scientific evidence. These practices must be clearly defined,
by practice guidelines, decision support tools, manuals or
algorithms to guide their implementation and performance and
outcome measurement.
3. Emerging Practices
Emerging practices are new, clearly defined innovations with
practice guidelines that address critical needs of a particular
program, population or system, but do not yet have scientific
evidence or broad consensus support.
- Scientific Evidence
Scientific evidence results from a study or research project
that has a rigorous controlled design (including a clearly
articulated hypothesis and rigorous methodology along with
controlled conditions and random assignments to various comparison
conditions), with experimental and control groups, that includes
sufficient subjects to overcome the possibility that the result
could have occurred by chance, and is repeated with the same
result in multiple sites with different researchers and different
experimental and control groups. Are published in peer-reviewed
journals within the discipline most appropriate for the subject
matter
- Outcomes
Outcomes are changes resulting from activities and product or
service delivery
