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Evaluating the Effectiveness of Evidence Based Health Care: \ud Where is the Evidence?

By Claire Parkin


Background: Credible evidence for the effectiveness of evidence-based health care training to\ud improve learner, patient and health system outcomes is essential for guiding, assessing, and\ud funding interventions.\ud Aims: To provide an overview of existing evaluation research on the effectiveness of EBHC\ud training, its limitations, and the knowledge gaps in need of further investigation.\ud Methods: To answer the question” How do we know that EBHC training makes a difference?” we\ud searched MEDLINE, EMBASE, COCHRANE and CINAHL with relevant MESH terms. Outcomes\ud included knowledge, skill, attitude, practice, judgment, competence, decision-making, patient\ud satisfaction, quality of life, clinical indicators, or cost. Selections limited to systematic reviews,\ud randomized controlled trials and pre/post studies published in any language. Retrieved articles\ud were critically appraised for validity prior to inclusion.\ud Results: Fifteen studies met our inclusion criteria: 5 systematic reviews, 4 randomized controlled\ud trials and 6 pre/post studies. There is modest evidence from systematic reviews and controlled\ud trials that undergraduate EBHC training improves knowledge but not skills and that clinicallyintegrated\ud post-graduate teaching improves both knowledge and skills. Two controlled trials\ud reported no impact on attitudes or behavior. One pre/post study found a positive impact on\ud decision making, while another suggested change in learner's behavior and improved patient\ud outcome. We found no studies assessing EBHC training for patient satisfaction, health-related\ud quality of life, cost, or population-level indicators of health.\ud Conclusion: Most of the literature evaluating the effectiveness of EBHC training has focused on\ud short-term acquisition of knowledge and skills. There is an urgent need for evaluation research\ud that provides solid evidence on the effect of EBHC training on learner's behavior, long-term\ud retention of acquired knowledge and skills, patient satisfaction, health and quality of life, and\ud health system outcomes

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