Clinical Strategy

Clinical Strategy (1)

   Within the Health Guardian’s Clinical Strategy, the ‘burning clinical question’ needs to be stated to drive clinical investigation, diagnostics, and care practice. This ‘burning clinical question' needs to be stated in PICOT format, or Patient population, Intervention or issue of interest, Comparison intervention or group, Outcome, and Time frame. This is to assure that the Health Guardian’s practice yields the most relevant and best evidence from a search of existing literature. The strategy should include a prioritization method for multiple questions, and prevents biased decisions based on that which the Health Guardian is most familiar with, or that which provides the least path of resistance. But rather, points the Health Guardian to the best and most relevant randomly controlled trials or other evidence.

   Strategic plans should include methods of conducting searches for best evidence by considering the elements of the PICOT questions. Each of the keywords from the PICOT question should be used to begin the systematic search. The strategy should include a hierarchy of evidence used to address interventions and/or issues. This is a suggested hierarchy for the different levels of evidence for each kind of PICOT question. Level - l Evidence from a systematic review of all relevant randomized controlled trials (RCTs). Level – 2 Evidence obtained from well-designed RCTs. Level - 3 Evidence obtained from well-designed controlled trials without randomization. Level – 4 Evidence from well-designed case-control and cohort studies. Level – 5 Evidence from systematic reviews of descriptive and qualitative studies. Level – 6 Evidence from a single descriptive or qualitative study. Level – 7 Evidence from the opinion of authorities and/or reports of expert committee. Although studies are compared and contrasted in narrative and integrative reviews, a rigorous methodology with explicit criteria for reviewing the studies is often not used, and a summary statistic is not generated. Therefore, conclusions and recommendations by authors of narrative and integrative reviews may be biased.

   The Clinical Strategy of the Health Guardian should also include critical appraisal methods of evidence including components of rapid critical appraisal, evaluation, and synthesis strategies. This is vital in that it involves critical appraisal of the evidence obtained from the search process. Although the Health Guardian may view critical appraisal as an exhaustive, time-consuming process, the first steps of critical appraisal can be efficiently accomplished by answering three questions as part of a rapid critical appraisal process in which studies are evaluated for their validity, reliability, and applicability to answer the clinical questions. These questions ensure relevance and transferability of the evidence to individual Health Guardian.

   How will the Health Guardian integrate the evidence with their clinical expertise and family preferences to make the best clinical decisions, and put evidence into action? Your Strategic Clinical Plan should outline this. In addition, consumers of healthcare services, and others impacted, want to participate in the decision-making process. It is the ethical responsibility of the Heath Guardian to figure out just how to involve all impacted in treatment decisions. A Health Guardian also needs to determine how to assess healthcare resources that are available to implement a specific treatment decision, which is a critical part of the Clinical Strategy. The extended family culture is another important consideration when implementing evidence into your practice.

   Your Clinical Strategy should also describe a plan for evaluating the outcomes of practice change-based on evidence. This type of evaluation is essential to determine whether the change-based evidence resulted in the expected outcomes when implemented in the real-world clinical practice setting. Measurement of outcomes is important to determine and document the impact of your healthcare quality and practice.

   Dissemination of the outcomes of the evidence-based practice is also an important part of your clinical strategy. All too often, Health Guardians achieve many positive outcomes through making changes in their care, based on evidence, but those outcomes are not shared with others, even family members facing the same issues. As a result, others do not build upon your outcomes nor the process that led to them, and Health Guardians and family members in other settings do not benefit from that knowledge.