Evidence-Based Standard of Care: Applications for Comparative Effectiveness and Efficacy Research and Analysis for Practice (CEERAP) in Developing Patient-Centered Optimal Treatment Interventions in Health Care for the Next Decade

Fig. 11.1

Evidence-based standards of care and translational effectiveness in CERRAP. The figure conceptualizes the progression of CEERAP from primary research to systematic reviews and onward to complex systematic reviews and clinically relevant complex systematic reviews. Each step involves a higher complexity and stringency of research synthesis. As the patient-clinician encounter establishes the fundamentals of translational research from does clinical setting to biopsy and biological samples of the patient back to the clinical environment, the process of research synthesis, whence emerges the best available evidence of efficacy and effectiveness, also requires “translation” into specific clinical settings (i.e., translational effectiveness). Evidence-based decision-making hence depends and derives from the best available evidence, and responds to the patient’s needs and wants, in perfect accord to the clinician’s expertise and the payment modalities (e.g., insurance coverage). It is at that stage that standards of care are revised based on the best available evidence and hence become “evidence-based.” In the modality summarized in this figure, it becomes evident that evidence-based decision-making, which arises from CEERAP, is intertwined with evidence-based standards of care. This triad – CEERAP<−>evidence-based decision-making<−>evidence-based standards of care – signify and define the overarching concept of translational effectiveness, which has permeated through the various chapters of this compilation of writing, from evidence-based endodontics to evidence-based nursing
Evidence-based research is disseminated through “systematic review (SR),” for the systematic nature of the process, and the comprehensive nature of the included bibliome. When several SRs are produced and must be pooled, validated instruments (e.g., R-AMSTAR [2], GRADE [3], PRISMA [4]) serve to evaluate the quality of each so that the acceptable sampling process may be applied [5] here as well. Pooled SRs in this manner yield “clinically relevant complex systematic reviews (CRCSRs).” Both SRs and CRCSRs are rather complicated, research jargon-laden, lengthy documents, which may be cumbersome to read. They are not the ideal mode of dissemination of the best available evidence. The field presents critical summaries (evidence reviews) of SRs and CRCSRs. These short reports are informative tools for the dentist and – since they are most often written in lay language – also empower the patients by raising health literacy.
Since all of these materials are produced and reported in paperless format, they are easily integrated in a health information technology protocol of paperless clinical charts and reports. In brief, our traditional view of the standard of care is intimately intertwined with the fundamental tenets of evidence-based health care (Fig. 11.1).
Possibly best stated, the following relationship between standard of care and evidence-based health care boils down to the fact that evidence-based health care consists of three important domains:

  • The best available scientific evidence
  • The dentist’s clinical skill and judgment
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Jan 5, 2016 | Posted by in General Dentistry | Comments Off on Evidence-Based Standard of Care: Applications for Comparative Effectiveness and Efficacy Research and Analysis for Practice (CEERAP) in Developing Patient-Centered Optimal Treatment Interventions in Health Care for the Next Decade
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