Evidence based practice - article appraisal

Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals

© 2022 Johns Hopkins Health System/Johns Hopkins School of Nursing P a g e | 1

Hierarchy of Evidence Guide Note: Refer to the appropriate Evidence Appraisal Tool (Research [Appendix E] or Nonresearch [Appendix F]) to determine quality ratings.

Evidence Level Types of Evidence

R es

ea rc

h E

vi de

nc e

(A pp

en di

x E

)

Level I • Experimental study, randomized controlled trial (RCT) • Explanatory mixed methods design that includes only a Level I quaNtitative study • Systematic review of RCTs, with or without meta-analysis

Level II • Quasi-experimental study • Explanatory mixed methods design that includes only a Level II quaNtitative study • Systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

Level III • Nonexperimental study • Systematic review of a combination of RCTs, quasi-experimental and nonexperimental studies, or nonexperimental studies only, with or without meta-analysis. • Exploratory, convergent, or multiphasic mixed methods studies • Explanatory mixed methods design that includes only a Level III quaNtitative study • QuaLitative study • Systematic review of quaLitative studies with or without meta-synthesis

N on

re se

ar ch

E vi

de nc

e (A

pp en

di x

F)

Level IV Opinion of respected authorities and/or nationally recognized expert committees or consensus panels based on scientific evidence. Includes:

• Clinical practice guidelines • Consensus panels/position statements

Level V

Based on experiential and non-research evidence. Includes: • Scoping reviews • Integrative reviews • Literature reviews • Quality improvement, program or financial evaluation • Case reports • Opinion of nationally recognized expert(s) based on experiential evidence