michigan informatics

From Evidence-Based Medicine to Evidence-Based Public Health

The evidence-based movement in the health sciences is over a decade old, and its beginnings are tied to evidence-based practice in medicine. The first appearance of the term evidence-based medicine occurred in the fall of 1990 in a document describing the residency program at Canada ’s McMaster University :

Residents are taught to develop an attitude of “enlightened skepticism” toward the application of diagnostic, therapeutic, and prognostic technologies in their day-to-day management of patients. This approach, which has been called “evidence-based medicine,” is based on principles outlined in the text Clinical Epidemiology. The goal is to be aware of the evidence on which one’s practice is based, the soundness of the evidence, and the strength of inference the evidence permits. The strategy employed requires a clear delineation of the relevant question(s); a thorough search of the literature relating to the questions; a critical appraisal of the evidence, and its applicability to the clinical situation; and a balanced application of the conclusions to the clinical problem. [1]

Some of the key concepts in this description are evidence and critical appraisal . Evidence can be defined as that “which furnishes proof,” and critical appraisal can be defined as an evaluation process “which determines the significance or worth of something by careful appraisal and study.” These concepts became a fundamental principle for a new approach to patient care, using evidence-based principles and a philosophy that evidence from the medical literature should support clinical decisions. As a body of literature began to emerge, it was soon recognized that evidence-based medicine approaches could be applied to other fields, including public health. Within this field, some of the principal user groups are practitioners, policy makers, researchers, the general public, and health sciences information professionals.

1. Guyatt, G. and Drummond Rennie. 2002. User’s Guides to the Medical Literature: A Manual for Evidence-Based Practice. Chicago : American Medical Association, p. xiv.