Can evidence-based medicine and clinical quality improvement learn from each other?

Abstract

The considerable gap between what we know from research and what is done in clinical practice is well known. Proposed responses include the Evidence-Based Medicine (EBM) and Clinical Quality Improvement. EBM has focused more on 'doing the right things'--based on external research evidence--whereas Quality Improvement (QI) has focused more on 'doing things right'--based on local processes. However, these are complementary and in combination direct us how to 'do the right things right'. This article examines the differences and similarities in the two approaches and proposes that by integrating the bedside application, the methodological development and the training of these complementary disciplines both would gain.

Figure 1

Relationships between Quality Improvement (QI) and Evidence-Based Medicine (EBM). (a) sequence of EBM followed by QI; (b) EBM uses clinical knowledge to inform individual clinical decisions about patient care; (c) QI focuses on improving recurrent problems in the processes of care (Acronyms: GIN—Guidelines International Network; EPOC—Effective Practice and Organisation of Care Group; IHI—Institute for Healthcare Improvement; BEME—Best Evidence Medical Education).

Figure 2

Proposed linkage between EBM and one model for QI.