National Practice Problem Exploration

Evidence-based practice (EBP) translates best available evidence into practice with the intention of influencing patient outcomes. Best available evidence includes research and nonresearch sources of evidence. When research evidence does not exist or is insufficient to answer a practice question, scholars can draw from a range of nonresearch evidence that has the potential to inform practice (Dang & Dearholt, 2018). Such evidence includes personal, aesthetic, and ethical ways of knowing (Carper, 1978), and it may include the expertise of the practitioner as well as the experience and values of the practitioner, patient, and patient's family. One type of nonresearch evidence that is particularly relevant to address a practice problem are clinical practice guidelines, or CPGs.

Clinical practice guidelines, or CPGs, are summary statements of research evidence. Clinical practice guidelines are statements that include recommendations intended to optimize patient care. They are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. The process used to write a CPG includes the formation of a team of interprofessional subject matter experts who review and include systematic reviews in their published recommendations.

It is important to note that a CPG is not classified as research evidence. The rationale relates to the possibility that a CPG may not be comprehensive. There is no assurance that the inclusion of research studies cited in a CPG is exhausted. Also, a CPG may not include a thorough appraisal of individual research studies. Over the past 15 years, there has been an exponential increase in CPGs, the majority of them published by professional organizations. CPGs are developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. They can play an important role in health policy formation, and they have evolved to cover topics across the healthcare continuum such as health promotion, screening, and diagnosis. Appropriate methodologies and rigorous strategies in the guideline development process are important for the successful implementation of the resulting recommendations. The quality of guidelines can be extremely variable, in fact, some fall short of basic standards. The potential benefits of CPGs are only as good as the quality of guidelines themselves.

The Global Burden of Disease Study measures what prevents us from living life in full health. The global burden of disease movement is now a worldwide effort with countries, including the United States, using the findings from the study—Global Burden of Disease—to inform research-based decision making. Healthcare leaders in the United States have examined the findings from the global burden of disease study through the lens of what this means to the overall health of Americans.

From this study, eight practice problems emerge as burdensome to the overall health of the United States. These eight practice problems include obesity; diabetes; heart disease; chronic obstructive pulmonary disease; mental illness; cancer; addiction, which includes alcohol and opioids; and patient safety, which includes any event in which an individual is harmed under our care.

Patient safety would include falls, pressure ulcers, hospital-acquired infections, and medication errors. Let's take a look—a high level look—at the prevalence and significance of these eight national practice problems. When we speak to the prevalence of the problem, we are referring to the rate of occurrence. Or another way to say it—this is the presence of the practice problem at the national level, and then at the local level. When we refer to the significance of a practice problem, we are speaking to the importance the problem has in preventing us to live a healthy life.