CMOs: Evidence-Based Medicine's Best Advocates

Philip Betbeze, for HealthLeaders Media , May 4, 2012

You can bet that as more research like this is published, showing that doing more of something provides no additional benefit, insurers and the Centers for Medicare & Medicaid Services will likely be watching closely, evaluating, and figuring out ways to incent hospitals and surgeons to adopt practice guidelines incorporating such findings—barring any extenuating circumstances.

In some cases, the penalties for noncompliance might be financial. But long before financial penalties for deviation from evidence-based medicine protocols, some hospitals and physician groups have been phenomenally successful in adopting them.

In fact, that's how many hospitals have successfully integrated evidence-based medicine protocols—by finding ways to have the physicians police themselves. And that is the challenge of leadership.

Just because new research is published and vetted is not sufficient to engineer change. Change can only come from a respected CMO who has the confidence of leaders on the surgical team. If he or she can convince them through research that certain practices are better for the patient and that the physicians will be evaluated on how closely they adhere to them, they'll change.

Peer pressure works.

Philip Betbeze is senior leadership editor with HealthLeaders Media.
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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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