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CD 5512 Clinical Management

What is Evidence-Based Practice?

Evidenced-based practice (EBP) is applying or translating research findings in our daily patient care practices and clinical decision-making.

The number of steps included in EBP can vary dependent on the particular model one is using ranging from five to seven steps. In this libguide, we will briefly look at two models with five steps.

Model 1 (Florida State University)

Five Step Model of Evidence-Based Medicine

  1. Convert information needs into answerable questions
  2. Track down with maximum efficiency the best evidence with which to answer them
  3. Critically appraise that evidence for its validity and usefulness
  4. Apply the results of this appraisal to your practice
  5. Evaluate your performance

Model 2 -  Five Step Model of Evidenced-Based Practice

Developed by Ascension University Medical Librarian, Michele Matucheski, this model uses five "As" to make it easier to remember the five steps.

     1. ASK: Information needs from practice are converted into focused, structured questions.

     2. ASSESS / ACQUIRE: The focused questions are used as a basis for literature searching in order to identify relevant external evidence from

     3. APPRAISE: The research evidence is critically appraised for validity.

     4. APPY: The best available evidence is used alongside clinical expertise and the patient's perspective to plan care.

     5. ASSESS / AUDIT: Performance is evaluated through a process of self reflection, audit or peer assessment.


Here is a short video discussing EBP.

Levels of Evidence

Levels of evidence (sometimes called hierarchy of evidence) are assigned to studies based on the methodological quality of their design, validity, and applicability to patient care. These decisions gives the "grade (or strength) of recommendation."

Level of evidence (LOE)


Level I

Evidence from a systematic review or meta-analysis of all relevant RCTs (randomized controlled trial) or evidence-based clinical practice guidelines based on systematic reviews of RCTs or three or more RCTs of good quality that have similar results.

Level II

Evidence obtained from at least one well-designed RCT (e.g. large multi-site RCT).

Level III

Evidence obtained from well-designed controlled trials without randomization (i.e. quasi-experimental).

Level IV

Evidence from well-designed case-control or cohort studies.

Level V

Evidence from systematic reviews of descriptive and qualitative studies (meta-synthesis).

Level VI

Evidence from a single descriptive or qualitative study.

Level VII

Evidence from the opinion of authorities and/or reports of expert committees.


This level of effectiveness rating scheme is based on the following: Ackley, B. J., Swan, B. A., Ladwig, G., & Tucker, S. (2008). Evidence-based

nursing care guidelines: Medical-surgical interventions. (p. 7)St. Louis, MO: Mosby Elsevier.

(Chart used with permission from Megan Peterson