Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Evidence-Based Practice
Lecture:Definition and application of EBM
Phrasing the clinical question
Slide content:Foreground Questions Have three or four essential components (PICO) Patient and/or problem Intervention Comparison intervention (if appropriate) Outcomes Example In an elderly patient with congestive heart failure, are beta blockers helpful in reducing morbidity and mortality without excess side effects? 16
Slide notes:16 Foreground questions have three or four essential components. One way to remember these components is the PICO [ pee - koh ] acronym. A complete foreground question has a patient and/or a problem (P). It also has an intervention (I), such as a treatment or a diagnostic test. If applicable, it includes a comparison intervention (C). And then it includes an outcome (O). If the question asks about a treatment, for example, it presents a patient (or patient group) with a specific disease and examines administration of a specific treatmentor intervention. If we are looking for evidence, we try to do a randomized control trial that compares that treatment with a control or a placebo group. Finally, the question searches for some kind of outcome. The treatment is either more effective or less effective than the control or placebo. With a diagnostic test, we may look at how accurate the test is, so we compare against a generally accepted gold standard. If we are investigating prognoseshow patients dowe may not necessarily have a comparison, in which case we follow the natural history of a disease. Here is an example of a foreground question: In an elderly patient with congestive heart failure where the heart is not pumping as strongly as it could, are beta blockers, which are a type of drug, helpful in reducing morbidity and mortality without excess side effects?