CMOs: Evidence-Based Medicine's Best Advocates

Philip Betbeze, for HealthLeaders Media , May 4, 2012

Essentially, the researchers found that by lowering hemoglobin threshold to 8 (instead of) 10, they used 66% fewer blood transfusions and they had no different outcomes between the two groups in length of stay, heart attack, stroke, death, and even the ability to walk.

The logical conclusion: If there's no benefit from giving extra blood, then all that's left is the additional cost and the potential for harm by giving more blood than is needed.

Certainly the research must be evaluated, but this is something that seems to make so much sense that it should change practices rather quickly, at least for physicians who are made aware of the news.

I'm not writing to pillory physicians and accuse the entire group of being unwilling to change. The approach to changing clinical practices has been uneven and I understand resistance to hearing from a non-physician that a physician should change the way he or she practices medicine given the physician's investment in a long academic career and apprenticeship (through residency).

Leadership means delegating this responsibility to the physicians themselves, and it's why a strong CMO role is essential.

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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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