Practice-based evidence study design for comparative effectiveness research.
OBJECTIVE
To describe a new, rigorous, comprehensive practice-based evidence for clinical practice improvement (PBE-CPI) study methodology, and compare its features, advantages, and disadvantages to those of randomized controlled trials and sophisticated statistical methods for comparative effectiveness research.


METHODS
PBE-CPI incorporates natural variation within data from routine clinical practice to determine what works, for whom, when, and at what cost. It uses the knowledge of front-line caregivers, who develop study questions and define variables as part of a transdisciplinary team. Its comprehensive measurement framework provides a basis for analyses of significant bivariate and multivariate associations between treatments and outcomes, controlling for patient differences, such as severity of illness.


RESULTS
PBE-CPI studies can uncover better practices more quickly than randomized controlled trials or sophisticated statistical methods, while achieving many of the same advantages. We present examples of actionable findings from PBE-CPI studies in postacute care settings related to comparative effectiveness of medications, nutritional support approaches, incontinence products, physical therapy activities, and other services.


CONCLUSIONS
Outcomes improved when practices associated with better outcomes in PBE-CPI analyses were adopted in practice.
Horn
Susan D
SD
International Severity Information Systems, Inc.; and Institute for Clinical Outcomes Research, Salt Lake City, Utah, USA. shorn@isisicor.com
Gassaway
Julie
J
D019317:Evidence-Based Medicine / Q000379:methods / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D009735:Nursing Homes; D019370:Observation; D003668:Pressure Ulcer / Q000517:prevention & control; D011785:Quality Assurance, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D000071939:Stroke Rehabilitation; D014481:United States