Evidence-based practice, research and quality improvement
Evidence-based practice, research and quality improvement
This domain tests whether you can use evidence, patient values and context to make decisions, and improve services. Expect questions on PICO, evidence hierarchies, critical appraisal, audit, PDSA cycles and equity-focused research.
Core concepts
- Form a focused question using PICO: population, intervention, comparison and outcome.
- Appraise validity, effect size, precision and applicability before changing practice.
- Evidence hierarchy is not a rigid ladder: a well-conducted qualitative or Kaupapa Māori study may answer questions that trials cannot.
- Integrate evidence with patient preferences, clinical expertise and local resources.
- Use audit and PDSA cycles to test small changes, measure outcomes and avoid unintended harm.
Worked example
You want to reduce missed appointments in a community clinic. You form a PICO question, review evidence on reminders, and run a small PDSA cycle with text reminders and whānau contact. You measure attendance and equity by ethnicity. Reasoning: evidence supports reminders generally, but local implementation and equity effects must be measured.
Traps
- Treating RCTs as the only useful evidence.
- Ignoring patient values and local context.
- Running audit without changing practice.
- Overstating results from small or biased studies.