Evidence-based medicine beyond the bedside: keeping an eye on context.
BACKGROUND
Evidence-based medicine is being applied to decisions in a range of contexts beyond one-to-one patient care. Yet considerable disagreement persists regarding the defining components of evidence-based decision-making, particularly in institutional and public health contexts.


OBJECTIVE
This article reviews the key elements of evidence-based decision-making for clinical medicine, and adapts those key elements and argues for their broad applicability to a variety of decision-making contexts including institutional, public health, and self-care decision-making contexts.


METHODS
Conceptual Analysis. Results Evidence based decision-making involves research evidence, "social and institutional circumstances", and "values" of stakeholders. Furthermore, evidence-based decision-making includes "judgment" exercised by experts to appropriately weigh and integrate the various decision-making elements.


CONCLUSIONS
Asking critical questions about the purposes and context of a specific decision, basic principles of evidence-based reasoning can be appropriately applied beyond the bedside.
Tilburt
Jon C
JC
Mayo Clinic, Rochester, MN, USA. tilburt.jon@mayo.edu
D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D019985:Benchmarking; D002983:Clinical Competence; D015510:Clinical Medicine / Q000193:education / Q000458:organization & administration*; D018672:Community Health Planning / Q000458:organization & administration; D003657:Decision Making; D003659:Decision Making, Organizational; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine / Q000193:education / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D007600:Judgment; D020380:Needs Assessment; D009937:Organizational Objectives; D010347:Patient Care Planning / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D015980:Public Health Practice; D012106:Research; D012648:Self Care; D012945:Social Values