Information Mastery: Applying EBM Principles at the Point-of-Care

The 5 A Framework assumes you have first ASSESSED a patient and come up with a clinical question. Next, you are ready to ASK your question.

We use an acronym called PICO to be sure we have included all important factors to consider when forming a good searchable question. 

PICO is a tool that clarifies and focuses questions that arise during a patient assessment, and helps to identify and organize the key aspects of a complex patient presentation.

Those key components include:

• P = Patient or Population
• I = Intervention (Are you looking to diagnose? Treat? Learn about a prognosis?)
• C = Comparison or Control - not a part of all questions (Is there a control? Placebo? Gold Standard?)
• O = Outcome (What do you hope to accomplish? Better treatment? Decreased mortality?

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PICO Examples:

• Will treating diabetic patients with HgA1c>8.0 (P) with sulfonylurea medications (I) reduce complications of diabetes (need for dialysis, blindness, stroke, MI, neuropathy, amputation) (O) compared to glucophage (C)?
• In ventilated patients (P), does the head of the bed elevation of 45 degrees (I) compared to 20 degrees (C) reduce the incidence of ventilated associated pneumonia (O)?
• In an 86- year old man with coronary artery disease (P), is aspirin (C) a more effective agent than heparin (I) in reducing stroke risk (O)?

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