Evidence-Based Management in Healthcare

Learning Goal: I’m working on a management report and need a sample draft to help me learn.

The PICO Question assignment is designed to give you, future healthcare managers, the opportunity to develop skills in designing a research question to address an issue facing your organization or patient population.

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Be sure to read through the entire assignment including the Evaluation and Grading Criteria before starting, so you’ll know what you will need to do to complete this assignment and be able to ask clarifying questions should you have any.

ASSIGNMENT COMPONENTS

After reviewing all the material for this week (which is chapter 18 of Textbook
Kovner AR & D’Aunno. Evidence-Based Management in Healthcare. 2nd Ed. Chicago, IL: Health Administration Press; 2017. nd) deciding on a topic of interest, conduct a literature review and formulate your research question using the PICO style approach. Provide evidence to support your question. Why is this important? (Please explain the relevancy of any sources older than 5 years.)

WRITING GUIDELINES

  • Provide a well-constructed paper that uses APA format.
  • There should be a separate title and reference page.
  • The body of the paper should be double-spaced in Times New Roman 12 point font with one-inch margins on each side.
  • There is no particular length equivalent for this paper; however, the paper must fully address all the points of the PICO requirements.
  • The paper should include a cover page and a list of references.
  • Introduction

    PICO (alternately known as PICOT) is a mnemonic which is used to describe the four elements of a good clinical question. PICO stands for:P–Patient/Problem
    I–Intervention
    C–Comparison
    O–Outcome

  • This is a very useful tool that supports to clarify a research question, which then assist in making it easier to find an answer. Use PICO to generate terms – these you’ll use in your literature search for the current best evidence. Once you have your PICO terms, you can then use them to re-write your question. (Note, you can do this in reverse order if that works for you.)PICO Use the PICO format to break down your question into smaller parts and identify keywords:

    PICO ELEMENTS CHANGE ACCORDING TO QUESTION TYPE (DOMAIN)

    When forming your question using the PICO framework it is useful to think about what type of question it is you are asking, (therapy, prevention, diagnosis, prognosis, etiology). The table below illustrates ways in which Problems, Interventions, Comparisons and Outcomes vary according to the type (domain) of your question.2 The intervention is what you are thinking might be a better approach to the problem. The Comparison or Control is what is presently used to treat, care, etc. the Patient Problem or Popualtion.

    Question Type Patient Problem or Population Intervention or Exposure Comparison or Control Example Outcome Measures
    Therapy (Treatment) Patient’s disease or condition. A therapeutic measure, eg., medication, surgical intervention, or life style change. Standard care, another intervention, or a placebo. Mortality rate, number of days off work, pain, disability.
    Prevention Patient’s risk factors and general health condition. A preventive measure, e.g., A lifestyle change or medication. Another preventative measure OR maybe not applicable. Mortality rate, number of days off work, disease incidence.
    Diagnosis Specific disease or condition. A diagnostic test or procedure. Current “reference standard” or “gold standard” test for that disease or condition. Measures of the test utility, i.e. sensitivity, specificity, odds ratio.
    Prognosis (Forecast) Duration and severity of main prognostic factor or clinical problem. Usually time or “watchful waiting”. Usually not applicable. Survival rates, mortality rates, rates of disease progression.
    Etiology (Causation) Patient’s risk factors, current health disorders, or general health condition. The intervention or exposure of interest. Includes an indication of the strength/dose of the risk factor and the duration of the exposure. Usually not applicable. Survival rates, mortality rates, rates of disease progression.

    Writing Your Question Statement

    Once you have clearly identified the main elements of your question using the PICO framework, it is easy to write your question statement. The following table provides some examples.

    Question Type Patient Problem or Population Intervention or Exposure Comparison or Control Outcome Measure
    Therapy In patients with osteoarthritis of the knee is hydrotherapy more effective than traditional physiotherapy in relieving pain?
    Prevention For obese children does the use of community recreation activities compared to educational programs on lifestyle changes reduce the risk of diabetes mellitus?
    Diagnosis For deep vein thrombosis is D-dimer testing or ultrasound more accurate for diagnosis?
    Prognosis In healthy older women that suffer hip fractures within the year after injury what is the relative risk of death?
    Etiology Do adults who binge drink compared to those who do not binge drink have higher mortality rates?

    References1. Schardt, C., Adams, M. B., Owens, T., Keitz, S., & Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Medical Informatics and Decision Making, 7, 16. doi: http://dx.doi.org/10.1186/1472-6947-7-12. Fineout-Overholt, E., & Johnston, L. (2005). Teaching EBP: asking searchable, answerable clinical questions. Worldviews On Evidence-Based Nursing, 2, 157-160.Fill in the blanks with information from your clinical scenario:

    THERAPY
    In_______________, what is the effect of ________________on _______________ compared with _________________?
    PREVENTION
    For ___________ does the use of _________________ reduce the future risk of ____________ compared with ______________?

    DIAGNOSIS OR DIAGNOSTIC TEST
    Are (Is) ________________ more accurate in diagnosing _______________ compared with ____________?

    PROGNOSIS
    Does ____________ influence ______________ in patients who have _____________?

    ETIOLOGY
    Are ______________ who have _______________ at ______________ risk for/of ____________ compared with _____________

    with/without______________?

    MEANING
    How do _______________ diagnosed with _______________ perceive __________________?

    Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.