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Computers are useless. They can only tell you answers.

—Pablo Picasso

*Mr. Ketterman's Case

While I have found lots of literature about individual aspects of Mr. Ketterman's care, I really need help thinking about his whole plan of care. Can't I find some information that will help me through the whole process from diagnosis and prognosis to selection of intervention and choice of outcome measurements? (See Appendix for Mrs. Ketterman's health history.)

As we have seen, studies (Chapters 12 and 13), synopses of studies (Chapter 14), and syntheses and synopses of syntheses (Chapter 15) all offer clinicians evidence that can help guide clinical decision making in patient-centered physical therapy care. But we also have seen that in almost all cases, this evidence is focused on one specific aspect of that care, be it diagnostic and prognostic tests or interventions. As clinicians, we want to understand the evidence about the full range of care we provide to patients. The efficiency of having the entire pattern of care reviewed becomes even more obvious when we are focusing on a patient population that represents a large part of our practice. Summaries and systems, the final two elements of Haynes's 6S pyramid (Fig. 16-1) offer us just such information.1,2 They integrate a range of evidence across available studies and syntheses to provide guidance about management of a particular health problem.1

Figure 16-1

Sources of Information About Evidence. (From DiCenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence: Fine-tuning the 5S model into a 6S model. Evid Based Nurs. 2009;12:99-101.)


Practice Guidelines

Perhaps the most common form of summary is an evidence-based clinical practice guideline.1,2 Because the term guideline is used in so many different contexts, we will take a step back to come to a common definition before proceeding with resources and examples. Eddy3 has described in detail the different kinds of policy statements available to guide care, as is shown in Figure 16-2. Along the width (x-axis) of the cube is the intended use of any policy, ranging from providing advice, through approvals for payment, to approvals for allowing practice, such as credentialing by facilities and insurance companies. Most of us have experienced policies governing each of these functions. In this chapter we are primarily interested in the use of policies based on evidence to provide advice, although it is certainly possible that payers and employers may develop policies based on evidence.

Figure 16-2

The Many different Types of Policy Statements That Can and Are Made. (Reprinted with permission from Eddy DM. A Manual for Assessing Health Practices and Designing Practice Policies. American College of Physicians; 1992.)

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