["Best practice" in health care--or why we need evidence-based medicine, guidelines and health technology assessment].
In this article we describe an interdisciplinary approach that aims at developing a framework for the definition of best practice in health care. Its focus is on Health Technology Assessment (HTA), Evidence-based Medicine (EBM) and Clinical Practice Guidelines (CPG), each of which being approaches that increasingly rely on systematic reviews of the best available evidence. The concept is based on an extensive literature search comprising key articles on HTA, EBM and CPG and all relevant related disciplines (e.g. clinical epidemiology, outcomes research). The origin of the term "best practice" is also traced. The framework for the definition of best practice in health care is an iterative loop. It consists of the overriding concept of health care based on reliable evidence. In this concept, HTA, EBM and CPG are related to each other in three "domains", input, implementation and outcome. Information that constitutes evidence is delivered through disciplines and evaluation methods in health care to the input domain. The implementation domain refers to methods to effectively translate evidence into practice as well as to implementation barriers. The outcome domain considers methods to monitor best practice. This implies that indicators of performance at different levels of health care have to be identified which could serve as measures of success. The outcome domain may serve as information source for the input domain (iterative loop). Research recommendations are centered around improving availability and use of evidence (including systematic reviews), and promoting existing activities in best practice.
Perleth
M
M
Abteilung Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover. perleth@epi.mh-hannover.de
Jakubowski
E
E
Busse
R
R
D020811:Biomedical Technology; D003695:Delivery of Health Care / Q000592:standards*; D019317:Evidence-Based Medicine; D005858:Germany; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012106:Research / Q000592:standards