Within the module on evidence-based medicine and hospital-based health technology assessment of the course in healthcare organization and management at the International European University, a lecture was delivered focusing on the methodological foundations of evidence-based medicine and its role in clinical and managerial decision-making at the level of healthcare institutions.
The lecture was delivered by our clinical assessment expert, Svitlana Soloviova.

Evidence-based medicine is understood as the conscious, explicit, and judicious use of the best available scientific evidence in medical practice, integrating research findings with clinical expertise and patient values. In the Ukrainian context, this approach is interpreted more narrowly as the conscientious and methodologically sound use of clinical research results to guide treatment choices and the provision of rehabilitation services with proven effectiveness and appropriateness (Order of the Ministry of Health of Ukraine No. 751 of 28.09.2012 “On the development and implementation of medical and technological documents for the standardization of medical and rehabilitation care in the system of the Ministry of Health of Ukraine”).

It was emphasized that evidence-based medicine is not limited to clinical decisions for individual patients. It also serves as the foundation for managerial and policy decisions aimed at improving the quality and safety of care and ensuring the rational use of limited healthcare resources.

In the context of healthcare institutions, evidence-based medicine plays a dual role. On the one hand, it ensures the justification of decisions regarding medical and rehabilitation services for individual patients or patient groups. On the other hand, it functions as a tool for managing both resources and quality. Participants reviewed how evidence- and knowledge-based care is embedded in 11 core quality criteria of the Ukrainian National Standard for Quality Management Systems in Healthcare — DSTU EN 15224:2019 (EN 15224:2016, IDT), aligned with EN ISO 9001:2015, effective from 01.01.2020. According to this standard, medical services (including diagnostics, treatment, prevention, and patient care) must be based on scientific evidence and/or knowledge-based experience and best practices.

It was stressed that the quality of healthcare depends not on isolated decisions but on the systematic application of medical knowledge across all processes within a healthcare institution. This implies the integration of evidence-based approaches into patient pathways, internal quality control systems, and managerial procedures.

A dedicated part of the lecture addressed the methodology of formulating questions for evidence searching, i.e., conducting systematic literature searches. A clearly formulated question determines the search strategy, the choice of sources, and the types of evidence to be included. Structured formats are used to guide this process, most notably the classic PICO framework (P – Population; I – Intervention; C – Comparator; O – Outcomes), which helps define the target population, the intervention, the alternative, and expected outcomes. Other formats were also discussed:

• PICO-based variants (PICOT, where T = Time; PICOS, where S = Study design, and others);
• Alternatives to PICO, such as TICO (Technology, Indication, Comparator, Outcomes) and SPICE (Setting, Perspective, Intervention, Comparison, Evaluation).

These approaches aim to establish clear inclusion and exclusion criteria for literature reviews and to ensure the completeness of collected data.

The hierarchy of evidence was reviewed, including systematic reviews and meta-analyses, randomized controlled trials, real-world evidence, and the role of grey literature (i.e., materials not published in peer-reviewed scientific journals: analytical reports of international organizations such as WHO, reports of government agencies and ministries such as the Ministry of Health, NICE, and FDA, reports of research institutions, including health technology assessment reports, as well as conference presentations, posters, and seminar materials). Particular attention was paid to the limitations of different types of studies and to the necessity of critical appraisal of evidence quality.

The lecture also addressed the interpretation of research results. It was highlighted that statistically significant results are not always clinically meaningful, and observed correlations do not necessarily reflect causal relationships. A practical example based on the analysis of hospital mortality and postoperative complications was discussed. Previously, a statistical correlation had been observed: more complications appeared to lead to higher mortality. However, once patient severity was taken into account, it became evident that severity was the true underlying cause of both outcomes.

This example illustrated two important points for hospitals:

• Fair assessment of staff performance. Without adjusting for patient severity, clinicians treating the most complex cases may appear to perform worse due to higher complication or mortality rates. Severity adjustment allows for a more accurate evaluation of actual performance.
• Identification of real problems. The analysis revealed which risk factors genuinely influence complications and mortality—from patient pathways to the hospital to postoperative protocols and infection control. This enables targeted improvement of processes, including those beyond the hospital setting.

This case underscores the importance of critical appraisal of evidence and data adjustment when making both managerial and clinical decisions in hospitals.

Overall, evidence-based medicine was presented as the methodological foundation for informed decision-making in healthcare. Its integration into management processes and hospital-based health technology assessment is a necessary condition for improving quality, safety, and the efficiency of resource use.