Evidence-based Clinical Interventions Research Articles

Practical Monitoring of Treatment Fidelity: Examples From a Team-Based Intervention for People With Early Psychosis.

Mental health programs can address many components of fidelity with routinely available data. Information from client interviews can be used to corroborate these administrative data. This column describes a practical approach to measuring fidelity that used both data sources. The approach was used in the Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program, a team-based intervention designed to implement evidence-based practices for people experiencing early psychosis suggestive of schizophrenia. Data indicated that the intervention was implemented as intended, including program elements related to shared decision making and a range of evidence-based clinical interventions.

Designing forgiveness interventions: guidance from five meta-analyses.

The Nursing Interventions Classification system includes forgiveness facilitation as part of the research-based taxonomy of nursing interventions. Nurses need practical guidance in finding the type of intervention that works best in the nursing realm. Five meta-analyses of forgiveness interventions were reviewed to illuminate best practice. The only studies included were meta-analyses of forgiveness interventions in which the authors calculated effect size. Forgiveness interventions were shown to be helpful in addressing mental/emotional health. Components of effective interventions include recalling the offense, empathizing with the offender, committing to forgive, and overcoming feelings of unforgiveness. The meta-analyses showed that people receiving forgiveness interventions reported more forgiveness than those who had no intervention. Forgiveness interventions resulted in more hope and less depression and anxiety than no treatment. A process-based intervention is more effective than a shorter cognitive decision-based model. Limitations of the meta-analyses included inconsistency of measures and a lack of consensus on a definition of forgiveness. Notwithstanding these limitations, the meta-analyses offer strong evidence of what contributes to the effectiveness of forgiveness interventions. The implications of the studies are useful for designing evidence-based clinical forgiveness interventions to enhance nursing practice.

Evidence-Based Upper Extremity Rehabilitation for Chemotherapy-Induced Peripheral Neuropathy of the Hands

To present an evidence-based clinical intervention for chemotherapy-induced peripheral neuropathy of the hands.

Research into practice: improving musculoskeletal care in general practice.

Musculoskeletal disorders such as back pain, neck pain, osteoarthritis, and rarer conditions like gout and inflammatory arthritis are the most common limiting long-term conditions in the UK.1 They represent a huge and growing burden on population health, accounting for 30% of all years lived with disability, and 7.5 million days lost from work each year. The challenge was recognised by the Chief Medical Officer and confirmed in the recent Global Burden of Disease report: ‘Although health-care cost and activity data confirm that these conditions consume massive UK health system resources, concerted public health and high-quality integrated medical care strategies are not implemented systematically. Interventions are available for musculoskeletal disorders, but to what extent the health system is delivering is unclear. Musculoskeletal disorders will only increase in importance in view of present trends and require more urgent policy attention.’ 1 General practice and primary care more generally have a critical role in meeting these challenges. Of the 300 million general practice consultations that occur in England every year, approximately one in six are for arthritis and musculoskeletal problems. An important feature of primary care is its capacity to address the needs of patients with long-term conditions such as musculoskeletal complaints; this includes responsibility for anticipatory and preventive care across the life-course, supporting patients to self-manage their condition, and delivery of evidence-based clinical treatment. Effective primary health care can improve the health and wellbeing of individual patients and their families, and reduce the health and economic impact of musculoskeletal disorders on the population as a whole. The Research Institute for Primary Care and Health Sciences at Keele University is a multidisciplinary collaboration between academics from general practice, clinical rheumatology, epidemiology, physiotherapy, psychology, and health services research, and clinical partners across the West Midlands and Cheshire. …

Impact of Performance Improvement Continuing Medical Education on Cardiometabolic Risk Factor Control: The COSEHC Initiative

The Consortium for Southeastern Hypertension Control (COSEHC) implemented a study to assess benefits of a performance improvement continuing medical education (PI CME) activity focused on cardiometabolic risk factor management in primary care patients. Using the plan-do-study-act (PDSA) model as the foundation, this PI CME activity aimed at improving practice gaps by integrating evidence-based clinical interventions, physician-patient education, processes of care, performance metrics, and patient outcomes. The PI CME intervention was implemented in a group of South Carolina physician practices, while a comparable physician practice group served as a control. Performance outcomes at 6 months included changes in patients' cardiometabolic risk factor values and control rates from baseline. We also compared changes in diabetic, African American, the elderly (> 65 years), and female patient subpopulations and in patients with uncontrolled risk factors at baseline. Only women receiving health care by intervention physicians showed a statistical improvement in their cardiometabolic risk factors as evidenced by a -3.0 mg/dL and a -3.5 mg/dL decrease in mean LDL cholesterol and non-HDL cholesterol, respectively, and a -7.0 mg/dL decrease in LDL cholesterol among females with uncontrolled baseline LDL cholesterol values. No other statistical differences were found. These data demonstrate that our PI CME activity is a useful strategy in assisting physicians to improve their management of cardiometabolic control rates in female patients with abnormal cholesterol control. Other studies that extend across longer PI CME PDSA periods may be needed to demonstrate statistical improvements in overall cardiometabolic treatment goals in men, women, and various subpopulations.

Introduction of Innovations in Clinical Practice with Older Adults

Older adults comprise 12% of the population but consume 36% of the nation’s health care resources (Rice & Fineman, 2004). While there are numerous drivers of health care costs (Yamamoto, 2013), there is strong evidence that the complexities and multidimensional nature of many of the chronic conditions impacting older adults (e.g., heart disease, cancer, mental health, etc.) are costly and require significant expertise in geriatric care across the health professions. The need is even greater when considering how rapidly our country is aging and that by 2050 older adults will comprise 20% of the U.S. population (Federal Interagency Forum on Aging-Related Statistics, 2012). Training programs today are not producing the numbers of geriatric experts needed to strengthen clinical practices in aging or infusing sufficient geriatric content into their curricula. These broad trends are true for Occupational Therapy as well. The goal of this special issue Innovations in Clinical Practice with Older Adults is to address this gap in knowledge and provide a “state of the science” update in social and behavioral gerontology for health care professionals and educators preparing the next generation of professionals to meet older patients’ needs. These papers address biological and psychosocial issues as well as the institutional and policy contexts that shape health care services and delivery. The papers included in this Special Issue were invited papers from authors who presented their research and clinical implications of this work at the Institute of Gerontology’s Issues in Aging Conference at Wayne State University in Detroit, Michigan in May 2013. This conference is an annual event targeting health care professionals, case managers, long-term care home administrators and others dedicated to improving the lives of older adults. As guest editors, we asked these contributors to prepare their papers to be especially relevant to occupational therapy, but also other health professions. We worked to ensure the papers were well-integrated with each other. We also encouraged authors to craft their papers with the intent of sharing evidence-based clinical assessment tools and interventions that were relevant and easy to use in any practice setting. The articles now include topics frequently confronted in community-based and long-term care settings, and also those incorporating “high tech” approaches to assessment and treatment to bedside approaches requiring “high touch” assessment and intervention. As editors we were committed to a special issue that included

African-American Breast Cancer Survivors Participating in a Breast Cancer Support Group: Translating Research into Practice

Despite an overall decline in mortality, breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer death among African-American women. As such, clinicians should prepare to address the unique sociocultural and psychological concerns encountered by African-American women breast cancer survivors. The objective of this study is to examine, using qualitative methods, the main coping facilitators used by African-American women as they transition across the cancer continuum. The identification of these facilitators was then aligned with culturally sensitive interventions most useful with women coping with cancer along the cancer continuum. This was a secondary analysis of 20 videotaped stories of African-American breast cancer survivors collected as a part of the Washington University Center for Excellence in Cancer Communications project. The interview began with a discussion of how the survivor first became aware she had breast cancer, followed by a series of open-ended probes used to explore the following themes: coping, relationships, health care system experiences, follow-up care, and quality of life living with breast cancer. Survivors discussed their experiences and advice for targeting needs at each cancer stage from screening to diagnosis, treatment, and then survivorship. Survivor narratives point to key evidence-based clinical intervention strategies at each stage of the cancer trajectory. This study found that survivors see a cyclical cancer course, whereby African-American breast cancer survivors serve an important role in the lives of unscreened women, newly diagnosed women, and women in treatment.

Factors Influencing the Decline in Stroke Mortality

Stroke mortality has been declining since the early 20th century. The reasons for this are not completely understood, although the decline is welcome. As a result of recent striking and more accelerated decreases in stroke mortality, stroke has fallen from the third to the fourth leading cause of death in the United States. This has prompted a detailed assessment of the factors associated with the change in stroke risk and mortality. This statement considers the evidence for factors that have contributed to the decline and how they can be used in the design of future interventions for this major public health burden. Writing group members were nominated by the committee chair and co-chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiological studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize evidence and to indicate gaps in current knowledge. All members of the writing group had the opportunity to comment on this document and approved the final version. The document underwent extensive American Heart Association internal peer review, Stroke Council leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. The decline in stroke mortality over the past decades represents a major improvement in population health and is observed for both sexes and for all racial/ethnic and age groups. In addition to the overall impact on fewer lives lost to stroke, the major decline in stroke mortality seen among people <65 years of age represents a reduction in years of potential life lost. The decline in mortality results from reduced incidence of stroke and lower case-fatality rates. These significant improvements in stroke outcomes are concurrent with cardiovascular risk factor control interventions. Although it is difficult to calculate specific attributable risk estimates, efforts in hypertension control initiated in the 1970s appear to have had the most substantial influence on the accelerated decline in stroke mortality. Although implemented later, diabetes mellitus and dyslipidemia control and smoking cessation programs, particularly in combination with treatment of hypertension, also appear to have contributed to the decline in stroke mortality. The potential effects of telemedicine and stroke systems of care appear to be strong but have not been in place long enough to indicate their influence on the decline. Other factors had probable effects, but additional studies are needed to determine their contributions. The decline in stroke mortality is real and represents a major public health and clinical medicine success story. The repositioning of stroke from third to fourth leading cause of death is the result of true mortality decline and not an increase in mortality from chronic lung disease, which is now the third leading cause of death in the United States. There is strong evidence that the decline can be attributed to a combination of interventions and programs based on scientific findings and implemented with the purpose of reducing stroke risks, the most likely being improved control of hypertension. Thus, research studies and the application of their findings in developing intervention programs have improved the health of the population. The continued application of aggressive evidence-based public health programs and clinical interventions is expected to result in further declines in stroke mortality.

Neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid analgesia.

The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own. To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research. This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980-2012 in PubMed and PubMedCentral online research databases. To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations.

Longitudinal kinematic and kinetic adaptations to obstacle crossing in recent lower limb amputees

Obstacle crossing is an important activity of daily living, necessary to avoid tripping or falling, although it is not fully understood how transtibial amputees adapt to performing this activity of daily living following discharge from rehabilitation. The objective of this study was to investigate the longitudinal adaptations in obstacle crossing in transtibial amputees post-discharge from rehabilitation. Longitudinal repeated measures. Seven unilateral transtibial amputees crossed an obstacle 0.1m high positioned along a walkway while kinematic and kinetic data were recorded at 1, 3 and 6 months post-discharge. At 6 months post-discharge, walking velocity had increased (0.17 m.s(-1)) with most participants self-selecting an intact lead limb preference. During swing phase, peak knee flexion (p = 0.03) and peak knee power absorption (K4; p = 0.01) were greater with an intact versus affected lead limb preference. Having crossed the obstacle, intact limb peak ankle power generation in pre-swing (A2; p = 0.01) and knee power absorption (K3; p = 0.05) during stance phase were greater when compared to the affected limb. Obstacle crossing improved, although a greater reliance on intact limb function was highlighted. Results suggested that further improvements to locomotor performance may be obtained by increasing affected limb knee range of motion and concentric and eccentric strength of the knee extensors and flexors. The novel objective data from this study establish an understanding of how recent transtibial amputees adapt to performing obstacle crossing following discharge from rehabilitation. This allows for evidence-based clinical interventions to be developed, aimed at optimising biomechanical function, thus improving overall locomotor performance and perhaps subsequent quality of life.

Continuous control of tracheal cuff pressure for the prevention of ventilator-associated pneumonia in critically ill patients

Ventilator-associated pneumonia (VAP) is a major cause of death, morbidity and costs in ICUs. Several evidence-based clinical interventions have been increasingly described for its prevention. However, continuous control of tracheal cuff pressure (Pcuff) is rarely mentioned in the latest clinical guidelines. This review focuses on the available data about the management of Pcuff in the ICU, including discontinuous and continuous control, and its impact on the prevention of VAP. Current discontinuous monitoring and adjustment of Pcuff, even well performed, is inaccurate in maintaining Pcuff in the target range. Underinflation (Pcuff<20 cmH2O) of tracheal cuff is an independent risk factor for VAP through microaspiration of contaminated subglottic secretions into the lower respiratory tract. Two main types of devices, electronic and pneumatic, have been developed for the continuous control of Pcuff. Both have shown effectiveness in maintaining Pcuff in recommended range in ICU patients, but only the pneumatic device has provided a reduction in microaspiration and VAP incidence. Continuous controllers of Pcuff represent effective, easy to use and timesaving devices in today's busy ICU environment. However, further studies are required to determine the impact of continuous control of Pcuff on VAP incidence, patient outcomes, antimicrobial consumption and to compare pneumatic and electronic devices, before generalizing their use in routine practice.

Assessing the Implementability of Clinical Pharmacist Interventions in Patients With Chronic Kidney Disease

Pharmacy practice studies have been criticized for presenting poor intervention description, which has serious implications when attempting to replicate interventions elsewhere. Evidence of improved outcomes for patients with chronic kidney disease (CKD) following pharmacist intervention exist in the literature, but similar concerns with intervention description have been raised. To assess the implementability of evidence-based clinical pharmacist interventions in patients with CKD, based on the information contained in the published manuscripts. PubMed was searched to retrieve systematic reviews addressing the role of pharmacists in patients with CKD. Primary studies describing clinical pharmacy services in CKD were subsequently extracted. To describe and characterize pharmacists' interventions, the DEPICT (Descriptive Elements of Pharmacist Intervention Characterization Tool) was applied. Studies were independently classified as "implementable" or "nonimplementable" by 2 authors, based on whether they could be easily implemented into practice using the description provided in the article. Finally, implementable interventions were grouped in different areas. Five reviews were retrieved, and 39 original studies were analyzed. Of these, 59.0% were classified as nonimplementable. Among implementable interventions, 6 evidence-based areas of pharmacist interventions were identified: anemia, renal osteodystrophy, and cardiovascular risk factors management, medication appropriateness evaluation and medication reconciliation, patient education and compliance, and cost containment. Information contained in most articles reporting pharmacist interventions in CKD is not sufficient to ensure the implementation of the service in clinical practice. Pharmacy practice research articles should be written with the aim of improving clinical practice and not just showing the results of pharmacists' interventions.

The Motivational Supervisor: Motivational Interviewing as a Clinical Supervision Approach

Motivational interviewing (MI) is an evidence-based clinical intervention used to elicit motivation for client behavior change. MI as a supervision style involves the same spirit, processes, and techniques used to cultivate supervisee development and change. This article describes the application of MI components to clinical supervision, detailing the processes of engaging, focusing, evoking, and planning. A case example depicting MI supervision is provided.

The Collaborative Assessment and Management of Suicidality (CAMS): An Evolving Evidence‐Based Clinical Approach to Suicidal Risk

The Collaborative Assessment and Management of Suicidality (CAMS) is an evidence-based clinical intervention that has significantly evolved over 25 years of clinical research. CAMS is best understood as a therapeutic framework that emphasizes a unique collaborative assessment and treatment planning process between the suicidal patient and clinician. This process is designed to enhance the therapeutic alliance and increase treatment motivation in the suicidal patient. Central to the CAMS approach is the use of the Suicide Status Form (SSF), which is a multipurpose clinical assessment, treatment planning, tracking, and outcome tool. The original development of CAMS was largely rooted in SSF-based quantitative and qualitative assessment of suicidal risk. As this line of research progressed, CAMS emerged as a problem-focused clinical intervention that is designed to target and treat suicidal "drivers" and ultimately eliminate suicidal coping. To date, CAMS (and the clinical use of the SSF) has been supported by six published correlational studies and one randomized clinical trial (RCT). Currently, two well-powered RCTs are under way, and various new CAMS-related projects are also being pursued. The clinical and empirical evolution of CAMS-how it was developed and what are the next steps for this clinical approach-are described here.

An Outcomes Approach to Stroke Care: The Importance of Teamwork and Evidence-Based Nursing Care

The Quality in Acute Stroke Care (QASC) was a cluster randomised control trial (CRCT) which evaluated the effectiveness of evidence-based clinical treatment protocols for the management of fever, hyperglycaemia and swallowing, in conjunction with multidisciplinary team building workshops, and a standardised interactive staff education program (collectively known as the Fever, Sugar, Swallowing (FeSS) intervention) to improve patient outcomes 90-days. We found that patients cared for in stroke units who received our intervention were 15·7% more likely to be alive and independent 90 days following their stroke. They also had significantly: fewer episodes of fever, lower mean temperatures, lower mean blood glucose levels, and better screening for swallowing difficulties.

Effectiveness of organisational infrastructures to promote evidence-based nursing practice.

Nurses and midwives form the bulk of the clinical health workforce and play a central role in all health service delivery. There is potential to improve health care quality if nurses routinely use the best available evidence in their clinical practice. Since many of the factors perceived by nurses as barriers to the implementation of evidence-based practice (EBP) lie at the organisational level, it is of interest to devise and assess the effectiveness of organisational infrastructures designed to promote EBP among nurses. To assess the effectiveness of organisational infrastructures in promoting evidence-based nursing. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, LILACS, BIREME, IBECS, NHS Economic Evaluations Database, Social Science Citation Index, Science Citation Index and Conference Proceedings Citation Indexes up to 9 March 2011.We developed a new search strategy for this update as the strategy published in 2003 omitted key terms. Additional search methods included: screening reference lists of relevant studies, contacting authors of relevant papers regarding any further published or unpublished work, and searching websites of selected research groups and organisations. We considered randomised controlled trials, controlled clinical trials, interrupted times series (ITSs) and controlled before and after studies of an entire or identified component of an organisational infrastructure intervention aimed at promoting EBP in nursing. The participants were all healthcare organisations comprising nurses, midwives and health visitors. Two authors independently extracted data and assessed risk of bias. For the ITS analysis, we reported the change in the slopes of the regression lines, and the change in the level effect of the outcome at 3, 6, 12 and 24 months follow-up. We included one study from the USA (re-analysed as an ITS) involving one hospital and an unknown number of nurses and patients. The study evaluated the effects of a standardised evidence-based nursing procedure on nursing care for patients at risk of developing healthcare-acquired pressure ulcers (HAPUs). If a patient's admission Braden score was below or equal to 18 (i.e. indicating a high risk of developing pressure ulcers), nurses were authorised to initiate a pressure ulcer prevention bundle (i.e. a set of evidence-based clinical interventions) without waiting for a physician order. Re-analysis of data as a time series showed that against a background trend of decreasing HAPU rates, if that trend was assumed to be real, there was no evidence of an intervention effect at three months (mean rate per quarter 0.7%; 95% confidence interval (CI) 1.7 to 3.3; P = 0.457). Given the small percentages post intervention it was not statistically possible to extrapolate effects beyond three months. Despite extensive searching of published and unpublished research we identified only onelow-quality study; we excluded many studies due to non-eligible study design. If policy-makers and healthcare organisations wish to promote evidence-based nursing successfully at an organisational level, they must ensure the funding and conduct of well-designed studies to generate evidence to guide policy.

Fibromyalgia: Diagnosing and managing a complex syndrome

The purpose of this clinical review is to clarify and discuss the diagnosis and management of fibromyalgia. This includes typical signs and symptoms, pathophysiology, concomitant disease states, differential diagnoses, and recommended pharmacologic and nonpharmacologic treatment modalities. The search included Evidence Based Medicine Reviews, Ovid MEDLINE, PubMed, and CINAHL. Search terms used: fibromyalgia diagnosis, fibromyalgia pathophysiology, incidence of fibromyalgia, fibromyalgia comorbidities, etiology of fibromyalgia, fibromyalgia treatment, American College of Rheumatology criteria. Search limited to sources from 1990 to 2010. Fibromyalgia is a complex muscular rheumatism that is not fully understood and often misdiagnosed. Signs and symptoms may overlap with many other conditions that must be properly ruled out to prevent diagnosis based upon arbitrary clinical judgment. Treatment is most beneficial when tailored to individual patient presentation, and further research is warranted, particularly in the domains of pathophysiology and efficacy of treatment options. An accurate knowledge of current research will aid the nurse practitioner in effectively prescribing evidence-based clinical interventions. Optimal fibromyalgia management can be achieved through a multifaceted treatment approach and is enhanced with early identification of the disease process.

In the NEWS A ROUNDUP OF NEWS AND INFORMATION FROM OUR COMMUNITY

In the NEWS A ROUNDUP OF NEWS AND INFORMATION FROM OUR COMMUNITY

Co-occurrence of obesity and patterns of alcohol use associated with elevated serum hepatic enzymes in US adults

The aim of this cross-sectional study was to present nationally representative findings on the co-occurrence of obesity and specific patterns of alcohol use associated with elevated serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase (GGT) among adults in the United States. We analyzed data from 8,373 adults aged≥20years who participated in the 2005-2008 National Health and Nutrition Examination Survey. We produced prevalence ratios by using the co-occurrence of obesity (i.e., body mass index≥30.0kg/m(2) or waist circumference≥102cm in men and≥88cm in women) and specific patterns of alcohol use (i.e., non-drinkers, non-excessive drinkers, and excessive drinkers) as a predictor; elevations in serum ALT, AST, and GGT were used as an outcome variable while adjusting for covariates in multivariate regression models. Approximately 34.7% of adult men and 38.6% of adult women in the United States had co-occurrence of obesity and any alcohol use, including 16.4% of men and 9.8% of women who had co-occurrence of obesity and excessive drinking during 2005-2008. When compared to male non-drinkers without obesity after multivariate adjustment, male excessive drinkers with obesity were 3.08 (95% CI: 1.80-5.28), 2.42 (95% CI: 1.80-3.26), and 3.15 (95% CI: 1.82-5.46) times more likely to exhibit elevated serum ALT, AST, and GGT, respectively. Similarly, when compared to female non-drinkers without obesity, female excessive drinkers with obesity were 2.36 (95% CI: 1.38-4.04), 3.27 (95% CI: 1.85-5.78), and 3.43 (95% CI: 2.19-5.40) times more likely to have elevated serum ALT, AST, and GGT, respectively. The co-occurrence of obesity and excessive drinking may place adults at an increased risk for potential liver injury. Our study findings provide support for evidence-based clinical and population-based interventions that integrate health behavior change among adults who have these co-occurring risk factors.

An Opportunity Map for Societal Investment in Health

MEDICAL CARE REFORM IS A CRITICAL PIECE IN achieving a healthy society but needs to be complemented by changes in community programs and policies. While the body of evidence-based clinical and population interventions is increasing, the challenge is to identify and implement those interventions that provide the greatest health benefits and value. A critical first step is to construct a sound, common framework for identifying and organizing the universe of evidence-based interventions. That framework can then be used to assess society’s investments in health. In this Commentary, we describe how 3 concepts—the ecologic model, the life course perspective, and evidence-based intervention strategies—contribute to a common goal and how they need to be viewed as integrated and complementary. A brief synopsis of each concept is provided, followed by a description of its fit within a broader conceptual framework.