The 2015 Revised Iowa Model for Infusing Evidence-Based Practices Globally

The Iowa Model of Evidence-Based Practice (EBP) to Promote Quality Care has stood the test of time as a heuristic, pragmatic model to infuse evidence into practice. Since February 2002, we have received 3,393 requests for permission to use the Iowa Model, including requests from all 50 of the United States, the territory of Puerto Rico, and 130 international requests from 38 countries. The model has been translated into German, Japanese and Portuguese.

To assure that the Iowa Model remains relevant in a rapidly changing healthcare arena and encourage its application globally, the model has been updated. We evaluated our local experiences; received input during regional, national, and international programs; reviewed the strengths and limitations of other models; and surveyed users about their experiences using the Iowa Model. Changes have been made throughout the model, based upon the knowledge gained.

The first change is in the triggers for initiating an evidence-based practice project. In earlier versions of the Iowa Model, triggers were viewed as either knowledge focused or problem focused. Since that time, there has been widespread recognition of the importance of evidence-based practice to improve patient care and outcomes. Regulatory bodies and accrediting agencies are requiring compliance with evidence-based quality performance measures. So, the original two types of triggers, no longer mutually exclusive, have been combined and enhanced to reflect these changes. A second step was added, “State the question or problem”. This step encourages users of the model to focus narrowly, with particular consideration given to the patient population. The third step, determining if the initiative is a priority, remains essential. This step emphasizes the need to determine if the needed support and resources are available to complete the process of the project and implement and sustain the practice change.

During the past ten years, there has been increasing importance placed on interdisciplinary collaboration. To address this trend, the fourth step, “Form a team of key stakeholders”, has been refined. This step emphasizes the need to identify and assure representation of all of those individuals who will be impacted by a change. The fifth step, “Assemble, critique, and synthesize the evidence,” combines two previous steps. In earlier versions of the Iowa Model, this activity was the most daunting for users. With the vast number of published systematic reviews and clinical practice guidelines, assembling and critiquing evidence is sometime streamlined. Although this step remains essential, it is no longer the central focus on the model.

If there is sufficient evidence, the next step is to “Design the practice change”. This involves considering the context in which the change will occur, the constraints and resources, approvals needed, and identification of other stakeholders. Based upon user feedback, this step was added to facilitate the process and avoid pitfalls. The next step is trialing the practice change. This step remains important to identify any refinement that is needed in processes before full implementation. If the change is appropriate, the information is disseminated internally. Next, a new step has been added, “Integrate and sustain the practice change”. This step is very important because it encourages a change in the culture of the practice setting and the ongoing expectation of adherence to the change. Lastly, the knowledge gained through the process should be disseminated externally as appropriate. This dissemination remains important to share the knowledge gained with others, and apply lessons learned globally. The 2015 revised Iowa Model of Evidence-based Practice to Promote Quality Care will be available at http://www.uihealthcare.org/otherservices.aspx?id=1617.