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Evidence Based Practice

Use this guide to learn about the first four steps of Evidence Based Practice, get help writing your PICO question, and get started on your research.

Ask: Write a focused clinical question

PICOT

Use the PICOT format to break down your question into smaller parts and identify keywords:

P

I

C

O

T

Patient / Population

Intervention / Indicator

Compare / Control

Outcome

Time / Type of Study or Question

Who are the relevant patients? Think about age, sex, geographic location, or specific characteristics that would be important to your question. What is the management strategy, diagnostic test, or exposure that you are interested in? Is there a control or alternative management strategy you would like to compare to the intervention or indicator? What are the patient-relevant consequences of the intervention? What time periods should be considered?  What study types are most likely to have the information you seek?  What clinical domain does your question fall under?
For example:
In adult patients with total hip replacements (Population), how effective is pain medication (Intervention) compared to aerobic stretching (Comparison) in controlling post operative pain (Outcome) during the perioperative and recovery time (Time)?

PICO Question Template Examples

It can be helpful to classify your question based on the clinical domain(s) it falls under.  

See below for definitions, PICO templates, and example questions from the primary clinical domains: intervention, diagnosis, etiology, prevention, prognosis/prediction, quality of life/meaning, and therapy.


Intervention

Questions addressing the treatment of an illness or disability.

In _________ (P), how does _________ (I) compared to _________(C) affect _______(O) within _______ (T)?
In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

In African American female adolescents with hepatitis B (P), how does acetaminophen (I) compared to ibuprofen (C) affect liver function (O)? (Time is optional).

 

Diagnosis

Questions addressing the act or process of identifying or determining the nature and cause of a disease or injury through evaluation.

Are (is) _________ (I) more accurate in diagnosing ________ (P) compared with ______ (C) for _______ (O)?
In ________ (P) are/is ________(I) compared with ________(C) more accurate in diagnosing ________(O)?
 

Is a PKU test (I) done on two week old infants (P) more accurate in diagnosis inborn errors in metabolism (O) compared with PKU tests done at 24 hours of age (C)? Time is implied in two weeks and 24 hours old.
In middle-aged men with suspected myocardial infarction (P), are serial 12-lead ECGs (I) compared with one initial 12-lead ECG (C) more accurate in diagnosing an acute myocardial infarction (O)?

 

Etiology

Questions addressing the causes or origin of disease, the factors that produce or predispose toward a certain disease or disorder.

Are ____ (P) who have _______ (I) at ___ (Increased/decreased) risk for/of_______ (O) compared with ______ (P) with/without ______ (C) over _____ (T)?

Are ______(P) who have ______(I) compared with those without _______(C) at ________ risk for/of _______ (O) over ________(T)?

Are kids (P) who have obese adoptive parents (I) at Increased risk for obesity (O) compared with kids (P) without obese adoptive parents (C) during the ages of five and 18 (T)?
Are 30- to 50- year old women (P) who have high blood pressure (I) compared with those without high blood pressure (C)at increased risk for an acute myocardial infarction (O) during the first year after hysterectomy (T)?

 

Prevention

Questions on how to reduce the chance of disease by identifying and modifying risk factors and how to diagnose disease early by screening.

For ________ (P) does the use of ______ (I) reduce the future risk of ________ (O) compared with _________ (C)?

In OR nurses doing a five minute scrub (P) what are the differences in the presence and types of microbes (O) found on natural polished nails and nail beds (I) and artificial nails (C) at the time of surgery (T)?

 

Prognosis/Prediction

Questions addressing the prediction of the course of a disease.

Does __________ (I) influence ________ (O) in patients who have _______ (P) over ______ (T)?
In _______ (P), how does ________ (I) compared to ________ (C) influence _________ (O) over _________ (T)?

Does telelmonitoring blood pressure (I) in urban African Americans with hypertension (P) improve blood pressure control (O) within the six months of initiation of the medication (T)?
For patients 65 years and older (P), how does the use of an influenza vaccine (I) compared to not received the vaccine (C) influence the risk of developing pneumonia (O) during flu season (T)?

 

Quality of Life/Meaning

Questions addressing how one experiences a phenomenon.

How do ________ (P) diagnosed with _______ (I) perceive ______ (O) during _____ (T)?

How do pregnant women (P) newly diagnosed with diabetes (I) perceive reporting their blood sugar levels (O) to their healthcare providers during their pregnancy and six weeks postpartum (T)?
How do 20 something men (P) with a diagnosis

 

Therapy

Questions around how to select treatments to offer our patients that do more good than harm and that are worth the efforts and costs of using them.

In _______(P), what is the effect of _______(I) on ______(O) compared with _______(C) within ________ (T)?

What is the duration of recovery (O) for patients with total hip replacement (P) who developed a post-operative infection (I) as opposed to those who did not (C) within the first six weeks of recovery (T)?

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