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

Abstract

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