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Essays on Evidence-Based Design as Related to Buildings and Occupant Health John Christopher Haddox This dissertation is comprised of three essays that explore the connections between buildings and their impacts on outcomes associated with occupant health. The essays are: 1. The Effect of Certified Green Office Buildings on Occupant Health: A Systematic Review and Meta-Analysis 2. Understanding Evidence-Based Design Through a Review of the Literature 3. Future Directions for Evidence-Based Design in Health Care Facilities Essay one, entitled The Effect of Certified Green Office Buildings on Occupant Heath: A Systematic Review and Meta-Analysis, explores the connections between certified green office buildings and their impacts on occupant health via the application of a systematic review and meta-analysis. An extensive literature search was conducted to locate any studies that examined the health of occupants in conventional buildings versus the health of the same populations after a move into a certified green building. The literature review followed the Cochrane Collaboration protocol for conducting systematic reviews. The results of a meta-analysis of the two studies uncovered by the systematic review show a positive relationship between certified green office buildings and improved occupant health (SMD 1.09), yet there was insufficient power (CI -0.88, 3.05). Essay two, entitled Understanding Evidence-Based Design Through a Review of the Literature, relates the current understanding of the concept of Evidence-Based Design (EBD), as specifically related to health care facilities, through the vehicle of an annotated bibliography of the relevant literature. EBD lacks a universally agreed upon definition, but one of the stronger definitions from the architecture discipline states that evidence-based design is a process for the conscientious, explicit, and judicious use of current best evidence from research and practice in making critical decisions, together with an informed client, about the design of each individual and unique project. The outcomes of primary concern with health care facilities tend to fall into three categories—patient/family outcomes, staff outcomes and fiscal outcomes. The thirty-one annotated articles reveal that the concept of EBD is quite complex, especially as it relates to the gathering and assessment of data and how such data is used to inform the building project. The bulk of the complexity lies with the word ‘evidence.’ The current literature suggests disparity among researchers and practitioners over the collection, assessment and incorporation of evidence related to the collection, analysis and incorporation of evidence into building projects that seek to have a positive impact on the three main outcome categories of interest in healthcare facilities—patient outcomes, staff outcomes and fiscal outcomes. Essay three, entitled Future Directions for Evidence-Based Design in Health Care Facilities, anticipates the future of evidence-based design as related to the design and construction of health care facilities. Reimbursement policies are driving health care to include more community based and customer services oriented delivery models. Pay based on performance—quality and efficiency of health care delivered—as well as customer satisfaction are taking on new importance and will drive designers of health care facilities to develop ever new methodologies for gathering and assessing evidence.