The IOWA Model was created by nurses at the University of Iowa Hospital and Clinics as tool to help clinical staff identify the best evidence to make healthcare decisions. This model uses problem focused triggers or knowledge based triggers.
Problem Based Triggers come from issues identified in the clinical setting. They are issues identified by staff as problems that need to be fixed. These triggers can be related to risk management, process improvement, benchmarking, financial, or identification of a clinical problem.
Knowledge Based Triggers are created when clinical staff identify an issue that they would like to know more about or a topic that more research is needed to understand. These triggers can be new research, standards, guidelines, philosophies, or questions about institutional standards.
The IOWA model uses a structured flow chart with decision points and feedback loops. The decision points move the project forward and the feedback loops manage and guide the changes suggested by the research. It uses seven clearly outline steps. They are:
Select a topic
Decide if the topic uses problem focused or knowledge based trigger. Using the flow chart decide if this topic is a priority for your organization and either consider other triggers or move on to number 2.
Form a team
The IOWA model uses a team to develop, implement, and evaluate the project developed from the topic. The team is often interdisciplinary and is tasked to do research, write policies, procedures, and guidelines based on the research as well as evaluation and assessment of any changes. Stake holders are important to the success of the project so time should be spent assembling a team with the appropriate skills and resources needed to complete the project.
Retrieve evidence
Using PICO or a different EBM model the team creates a research question that can then be investigated. This is the basis of the research and evidence gathering that will be done during this phase of the project. The team will be tasked to search relevant databases to find articles, reviews, and other data that will be evaluated and used to create the finished product for the project.
This is when you should consult a medical librarian to help you both construct the research question and search databases. You may need to request a literature search or meet with a librarian to learn how to find the resources you need for your project.
Grade the evidence
Once the research is complete and the appropriate articles and reports have been located this is the phase where the team will evaluate and synthesize the evidence and start to create drafts of the guidelines, policies, treatment plans etc. needed for the completion of the project. The feedback loop for this stage of the model asks you if there is enough evidence to move forward or not. This phase may identify that more research is needed.
Develop an EBP standard
This phase is when the team works to create the finished products identified at the start of the project.
Implement the EBP standard
This phase is when the team decides if the suggested changes or standards are appropriate for adoption in the clinical setting. It may test the standards or guidelines in a clinical setting and gather feedback from staff involved in implementing the new plan.
Evaluate the EBP standard
During this step the team evaluates the newly created standards or policies, reflects on the implementation and decides if the new process is useful in the clinical setting. Process improvement may occur at this stage if the initial implementation is not successful.
At the end of the process the team should decide to whether to share the project and results with the broader community. An article or a presentation at a professional conference may be created to share the research and outcome with other organizations.
Using the IOWA model is easy and has the advantage of being a practical application of the EBP process. It is easy to follow and the steps help you identify any issues that may arise in your project.
The Talbot Library’s new IOWA Model page which is part of the Evidence Based Medicine Subject Guide can help you get started on your research project. If you would like to learn more about the model, PICO questions, Evidence Based Practice, or research please reach out to the library for assistance
