CMOs: Evidence-Based Medicine's Best Advocates

Philip Betbeze, for HealthLeaders Media , May 4, 2012

That last factor is a particularly important catalyst to change.

I got to thinking about evidence-based medicine upon reading news of some important research from Johns Hopkins Hospital. Reported by my colleague Cheryl Clark earlier this week, the research surrounding blood transfusions in surgery could provide an interesting test case to determine how difficult it remains to incorporate evidence-based medicine protocols and change current surgical practices.

According to the story, the evidence boils down to this:  

    Current research says transfusions for most surgeries should not be initiated until the patient's hemoglobin level—normally 12 to 14—has dropped to 6 or 7 grams per deciliter (g/dl).  A level of 7 or 8 is considered safe. But the recommendations of three specialty societies that guide current practice leave the trigger point in question. "They say that if a patient's hemoglobin level is less than 7 g/dl, then the patient would benefit from a blood transfusion. But if it's greater than 10, they would not benefit. But they don't say what should be done if the level is between 7 and 10," Steven M. Frank, MD, leader of the study, said during an interview. Thus, many surgeons initiate transfusion when levels are at 10, while others start at 9 or 10 or 11.  Additionally, surgeons vary in the target point at which they stop transfusing. Some stopping at 11 or 12, even though they could stop at 10.


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1 comments on "CMOs: Evidence-Based Medicine's Best Advocates"

David A. Burton, MD (5/4/2012 at 5:37 PM)
In order to catalyze change behavior change in physicians (and other clinicians), there are a few prerequisites, including, for example: 1. The evidence for the clinical effectiveness guideline being advocated must be credible and available. Few physicians practicing on the front lines (in ambulatory or hospital settings)have time to do a literature search, identify and consult national experts and digest the information into a usable knowledge base. Even many CMOs do not have the infrastructure to provide this resource. Bottom-line: We need better systems to transform credible, commercial grade Clinical Content into clinical effectiveness guidelines (e.g., diagnostic algorithms). 2. Clinical effectiveness guidelines need to be available at the point of care. Once the guidelines are available, they need to be loaded into an EMR, so they are readily available "just-in-time" when they are needed. We need to "make it easy for physicians to "do the right thing" 3. The outcomes of implementing clinical effectiveness guidelines need to be measured and reported. Analytic feedback engages physicians. Outcomes should be measured not only in the research study, but also in the everyday implementation of the findings of the study. 4. The reports of the outcomes need to be provided to physicians in a format (visualization) that is easily understand. Tables of numbers are not very easy to comprehend. Graphical display is essential. 5. Analytic feedback should be used to create a learning environment not for punishment. The idea of using data regarding outcomes to "rank and spank" the outliers will destroy any hope of physician engagement. 6. Financial incentives need to be aligned. Financial incentives should not be expected to drive clinical behavior, but they can reinforce behavior, provided behavior can be tied causally to better outcomes. Thanks for the study. David A. Burton, MD Chief Executive Officer




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