Creating a focused clinical question is a key step in EBM.
This page provides information on the EBM process, how to use PICO(TT) to form a clinical question, and the hierarchy of evidence that can be used to answer the question.
*Adapted from model used on UNC/Duke EBM Tutorial available at http://www.hsl.unc.edu/Services/Tutorials/EBM/studies2.htm
Use the PICO(TT) Format to develop specific and answerable clinical questions.
|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.
|Type of Question||Type of Study/Methodology|
|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
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