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Evidence-Based Practice: ASK - PICO

This guide is designed to assist health care professionals to become effective and efficient users of the medical and nursing literature.

Background vs. Foreground Questions

When to use PICO ...

Background questions concern general knowledge.   These types of questions generally have only 2 parts:
A question root (who, what, when, where, how, why) and 
a disorder, test, treatment, or other aspect of health care.   
Often these questions can best be answered by using a textbook or consulting a clinical database.

Example Background Question  : What are the best interventions to prevent accidental falls in the elderly?

Foreground questions are specific knowledge questions that affect clinical decisions, including a broad range of biologic, psychological, and sociologic issues.  These are the questions that generally require a search of the primary medical literature and that are best suited to the PICO format.


What is the P.I.C.O. Model?

Defining a clinical question in terms of the specific patient problem aids the searcher in finding clinically relevant evidence in the literature. 

Essentially, PICO is a focused search strategy.

P.I.C.O. Model for Clinical Questions

 P   Patient, Population, orProblem   How would I describe a group of patients similar to  mine? 
I  Intervention, Prognostic Factor, or  Exposure   Which main intervention, prognostic factor,
 or exposure am I considering?
C  Comparison or Intervention (if  appropriate)   What is the main alternative to compare 
 with the intervention?
O   Outcome you would like to   measure or  achieve  What can I hope to accomplish, measure, 
 improve, or affect?
T  Time Interval  What is the time interval to acheive desired outcomes?
   What type of question are you  asking?  Diagnosis, Etiology/Harm, Therapy, Prognosis,
   Type of study you want to find  What would be the best study design/methodology?

Example PICO Questions

Therapy / Intervention Example :  In the elderly (P), does aspirin (I) reduce the risk of heart attacks (O)?

Intervention Example : In hospitalized adults (P), how does a Rapid Response Team (I) affect the number of cardiac arrests (O) and unplanned admissions to the ICU (O) during a 3-month period?

Diagnosis Example : In healthcare settings, does screening for intimate partner/domestic violence (I) improve quality-of-life (O) for women (P)?

Meaning Example : How do family caregivers (P) with relatives receiving hospice care (I) receive the loss of their loved one (O) during end-of-life (T)?

Comparative Intervention / Therapy Example :  In patients with dementia who are agitated (P), how does baby doll therapy (I) compared with Risperdone drug therapy (C) affect behavior outbursts (O) within 1 month (T)?

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