Research Guides: Evidence-Based Clinical Practice Resources: Process & PICO(TT)

EBM Process

This guide focuses on the second and third components of the EBM process.

Assess the patient
Ask focused clinical questions : Using PICO
Acquire the best evidence : find the recommended level of evidence for the type of clinical question being asked. If that level is unavailable use the evidence pyramid to determine the next best option.
Appraise the evidence critically
Apply evidence to patient care

It is important to remember that when seeking evidence that not all evidence is equal. It is important to seek out the recommended study level as well as evaluate the evidence.

Focused Clinical Questions & PICO(TT)

Use the PICO(TT) Format to develop specific and answerable clinical questions.

PICO description
PICO Format	Definition & Questions to Consider
P	Patient, Population, or Problem What are the characteristics of the patient or population? What is the condition or disease in which you are interested?
I	Intervention or Exposure What do you want to do with this patient (e.g., treat, diagnose, observe)?
C	Comparison or Intervention (if appropriate) What is the alternative to the intervention (e.g., placebo, different drug, surgery)?
O	O = Outcome What are the relevant outcomes (e.g., morbidity, death, complications)?
T	Type of Clinical Question Diagnosis, Etiology/Harm, Therapy, Prognosis, Prevention
T	Type of Study Design to Answer the Question What would be the best study design/methodology (Systematic review, RCT, cohort study, case control, etc.)

*Descriptions from the University of Washington Evidence-Based Practice LibGuide at http://libguides.hsl.washington.edu/content.php?pid=231619&sid=1931590

Knowing the Type of Clinical Question will help you determine the best type of study design. The table* below demonstrates the types of studies generally recommended to answer particular types of clinical questions.

Clinical Question Types
Type of Question	Type of Study/Methodology
Diagnosis	controlled trial
Therapy	double-blind RCT, Systematic review / meta-analysis
Prognosis	cohort studies, case control, case series
Harm/Etiology	cohort studies, case control, case series
Prevention	randomized controlled trial, cohort studies
Quality improvement	Randomized controlled trials

*Table adapted from http://researchguides.uic.edu/content/php?pid=47981&sid=353409

PICO - Adapted to other Question Types
	For Diagnosis	For Prognosis	For Risk, etiology or harm
P	Patient	Patient	Patient
I	Test	Prognostic Factors (Such as: disease state, comorbidity, or demographic factor)	Risk Factor
C	Standard	Absence of Prognostic Factors	Absence of Risk Factors
O	Outcome	Outcome	Outcome