Evidence-Based Practice in Decision Making

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The concept of evidence-based practice stems from two disparate fields, medicine and CIA intelligence work.

Formally, Evidence-Based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimum clinical care to patients. Evidence is defined as any data or information used to identify health problems, to assess their magnitude, to explain them and to make decisions about solution.

In medicine, this "evidence based" concept dates back to the 1980s (the term from the early 90s) when the focus within health care shifted from trust, conviction and authority to the use of the best available research and practice. The problem faced by the medical profession is that much of the research data (evidence for diagnosis, prognosis and therapy) is not accessible and in a form usable by clinicians. It is buried in too many journals and in poorly indexed systems, so that it is nearly impossible to use much of the information in practice.

The medical field has begun to address the problem of making decisions based on this information. They are still focused on finding the right information (i.e. evidence) and getting it to practitioners in a form that they can use to make decisions. But, they have little focused on supporting the actual decision-making process with this evidence. The Accord tool suite will make this possible.

The CIA has long had the charge of collecting and judging evidence on which critical national decisions are based. In the CIA's classic book The Psychology of Intelligence Analysis, the author Richards Heuer develops an evidence-based process:

Identify the possible hypotheses to be considered.
List the significant evidence and assumptions for and against each hypothesis.
Draw tentative conclusions about the relative likelihood of each hypothesis.
Analyze sensitivity of the conclusion to critical items of evidence.
Identify future observations that would confirm one of the hypotheses or eliminate others.

To support medical, intelligence or any other decisions, the Accord tool suite supports the following process:

Itemize the alternatives, the potential diagnoses in medicine or the alternative hypotheses in intelligence
Identify the criteria, the measures that are important to differentiating among the alternatives
Collect evidence to measure how the uncertain evidence supports or denies the hypotheses or potential diagnoses. Use this uncertain, conflicting, incomplete, evolving evidence to evaluate the alternatives
Evaluate the alternatives versus the criteria using the evidence
Use computed metrics for satisfaction, probability of being best and risk to draw tentative conclusions about the alternatives
Use the what-to-do-next analysis to understand the sensitivity to current and new evidence, and to identify the value of future evidence.

You can explore how Accord supports evidence-based practice for free either with the web-based Accord Instant Decision for a limited set of predefined problems, or Accord Professional, the 30-day free trial.

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