From 'Cookbook' to Evidence-Based Medicine

Philip Betbeze, for HealthLeaders Media , March 4, 2011

Once upon a time, physicians, as a group, resisted attempts by private payers and others, to force them to practice safer, more efficient medicine by standardizing patient interventions and the timing of those interventions based on disease states.

Why? Something was lacking. Make that a lot of somethings. The ability to crunch outcomes data from many sites of care was a critical unmet need in previous efforts to standardize care and eliminate duplicative and inefficient medical decisions that cost the health system billions. It was simply impossible to collect this data and draw conclusions from it to recommend changes in care pathways.

At the time, physicians were on solid ground in refusing to follow so-called evidence-based guidelines. They were able to successfully argue that the practice of medicine is largely an art, with wide variations in outcomes more dependent on patients' differences than on their common disease states.

Sometimes, these rules and regulations limited the physician's ability--based on his or her medical education--to treat the patient as he or she saw fit. But most importantly, the evidence for some of the rules was incomplete, flawed, and, they argued, it was being forced upon them by health plans. Some argued that such rules were based more on saving costs than on the improving the welfare of the patient. It was impossible to standardize treatments for patients with certain maladies because each patient reacted differently to the types of care prescribed, they said.

That critical contention was wrong, and now that reams of data from thousands of patients with similar disease states can be sliced and diced, it's becoming evident (no pun intended) that best practices, should they be followed, are better not only for patient outcomes, but for costs as well.

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2 comments on "From 'Cookbook' to Evidence-Based Medicine"

Michael Cadger, CEO (3/7/2011 at 12:37 PM)
Evidence-based outcomes have been discussed for decades with virtually no progress [INVALID] for many reasons but one common theme, the greatest impediment and most absurd myth: adoption requires physician consensus. If evidence-based outcome tools are to be accepted, there must be a re-prioritization of stakeholder "buy-in". Employers pay for all health care costs (either directly or through taxes) so their approval trumps all other stakeholders. In that respect, the ROI to employers of evidence-based outcomes is the key driver to adoption. Make evidence-based outcomes transparent on a provider-specific basis in employer health plans and watch the stampede of consumers flocking to the best value providers as the poor performing providers scurry to improve efficiency and quality. Practice pattern and price disparity will virtually overnight; while quality will improve. Let's eliminate this artificial barrier that stymies evidence-based outcomes. And let full transparency and market forces apply to health care just like every other sector of a free-market economy. Employers, transparency and free-market competition are the answer. Michael Cadger, CEO Monocle Health Data, LLC

Lisa Sams MSN, RNC (3/4/2011 at 6:14 PM)
Clearly technology is an essential tool to speed the adoption of evidence based practice. This article speaks to only one facet of our laggardly use of evidence to improve care for our patients. The environment of care itself is central to how, why and when clinicians adopt innovation. Greenlaugh and team's extensive work with the complexity of organizational cultures offers insights that can aid the success of new tools outlined in this article. Tools will help, but quality clinical care will only be achieved when we learn to work as high functioning interprofessional teams committed to improving outcomes for the people who depend on us...our patients.




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