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Evidence Based Medicine
David B. Nash, MD, MBA, is professor of health policy, and associate dean, Jefferson Medical College. Here, he defines evidence-based medicine (EBM), discusses the etiology of the term, crediting Dr. David Sackett of McMaster University in Hamilton Ontario with coining it, and proposes some ways to make EBM more of a reality than an ideal. Dr. Nash opens his lecture with Dr. Sackett's definition of evidence-based medicine as: "conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients," but points to the difficulty of "our ability to operationalize that definition." Even so, the author believes that the work of the Northern New England Cardiovascular Group, for example, shows that astute observation of one's experience and sharing that information with others in a highly organized format leads to better outcomes. That, says he author, is the application of the science of evidence-based medicine to everyday practice. And the Pennsylvania Healthcare Cost Containment Council, he says, has shown that managed care organizations applying evidence-based medicine had better outcomes at lower cost. The author lists Dr. Sackett's five reasons why clinicians should pay close attention to evidence-based medicine, including continuous new evidence, use of technology, keeping up-to-date, and accepting evidence-based protocols developed by others. Standardization and simplification, mutual assistance and structured information exchange rather than a "slavish adherence to autonomy and customization" will pave the way to implementing evidence-based medicine, says Dr. Nash. Clinicians can access and become familiar with guidelines and protocols through the Agency for Health Care Research and Quality. Making evidence-based medicine a reality will call for accountability, and benchmarking our performance compared with our peers. But first there's a need to create financial incentives for evidence-based medicine, to improve information systems, and to foster an organizational structure that supports quality improvement. |
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