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What is the issue I want to address? What are my evidence needs to help address it?


The commissioning cycle

The commissioning cycle is a useful starting point for identifying evidence requirements associated with each stage: strategic planningprocuring services and monitoring and evaluation.

Identifying and articulating evidence requirements early on will help you define practical options on which to base commissioning decisions. Gathering evidence at a later stage to validate a final decision, could be costly or time consuming. Use the Joint Strategic Needs Assessment (JSNA) as one key source of evidence, to inform planning, as this sets out the current and future needs of the local population. Service provision can be assessed against this to understand where gaps may exist. Public Health within the Local Authority are responsible for leading the development of this resource.

But before you do this, you need to clarify what the problem or issue is that you want to address before proposing a solution!

Once this is clarified, the PICO technique, outlined below, is a popular tool to help confirm what evidence is required for an evidence search, to help you solve your problem/issue.

Don’t forget evaluation at this stage. Early planning is important to understand what level of evaluation might be needed to inform future commissioning decisions. Advice and guidance is available via the Evaluation Toolkit.

Using PICO to help identify relevant evidence

PICO is a useful way  to structure commissioning questions appropriately, to make the best use of any evidence review or literature search.

A carefully focused question will speed up the search. We often start with too broad an information need, which can make the search process a lot harder. Focussing down is more likely to generate search results targeted at the specific issue you want to address.

A well-structured question usually contains four parts, summarised as ‘PICO’. Using PICO prior to an evidence search may help towards successful evidence-based commissioning. Start with a broad question such as, “What do I want to find out about?” e.g. primary eye care services. Then focus on what exactly you need to know using PICO:

P – patient, population and problem

What population/group of patients are you interested in? How would you describe them? Any sub-groups? What is the problem you need to address for them? Be specific, but brief. Example: Adults with a minor eye injury.

I – intervention indicator

What interventions, treatments and approaches are suitable for this group? What am I considering? Again, be specific and brief. Example: Primary eye-care services.

C – comparison

Are there alternative interventions to consider and compare? (this stage may not be necessary for commissioners) Example: No investment in primary eye-care services.

O – outcomes

What outcomes can you measure? What can you hope to accomplish or what could the treatment affect? Example: Reduced accident and emergency attendance.

Here is an example:

P – Patients on long flights
I – Compression stockings
C – No compression stockings
O – Prevention of deep vein thrombosis

Using this PICO it is now possible to structure a clear research question:

In patients on long flights, do compression stockings prevent deep vein thrombosis?

Try using your PICO terms to run a search and find the most relevant evidence.

Finding it difficult to grasp PICO?

Watch this video from the University of the West of England or read more on PICO from the Centre for Evidence-Based Medicine (University of Oxford)

Knowledge Sharing

Has someone done a similar search before? Check with your local public health team or library service.

Case study: Referral management strategies

Referral management strategies

This case study follows the 5 step process for accessing and using evidence in response to a request from commissioners to identify strategies for referral management to reduce unnecessary referrals.

See full case study