7. Synthesis: putting evidence to work, one improvement cycle at a time

The entirety of our previous discussion revolved around the levels of scientific evidence, various aspects of their interpretation and implementation, as well as grades of recommendations outlined in the overall context of EBM-based discussion. At this point, it will be important for the reader to become familiar with some of the methodologies employed in healthcare quality and patient safety improvement efforts. It is critical to emphasize that these approaches not only rely on EBM for planning and assessment but also help modify our existing EBM patterns through a continuous process improvement cycle. While evidence-based medicine has focused on providing the most recent evidence-based care for patients, quality improvement has focused more on the way we provide that care [140]. The evidence must be reviewed to ensure that it is indeed the right care while there also needs to be a clinical improvement process to implement the change or evidence-based care. The two most common formats used in the areas of healthcare quality improvement and patient safety are the PDCA (or Plan-Do-Check-Act, Figure 2) and the 5A's (Assess-Ask-Acquire-Appraise-Apply, Figure 3) methodologies [141–147]. The goal of these performance improvement approaches is to achieve the desired results and continue on to another part of the process [107].

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