Following the Evidence

How does your doctor decide which treatment to apply when you come to her with an illness? Does this seem like a dumb question? To those of us without medical training, it may seem like the arcane knowledge of health care professionals is consistent from doctor to doctor. If a man is diagnosed with diabetes, for instance, wouldn’t any doctor he sees dole out the same advice and medications? If a new and better treatment for diabetes had just been approved for use by the Food and Drug Administration, wouldn’t the doctor use that?

Not necessarily. Consider:

• According to the “Crossing the Quality Chasm” study conducted in 2000 by the Washington, D.C.–based Institute of Medicine, it takes an average of about 17 years before new knowledge generated by randomized controlled trials (the most trusted research method) is incorporated into medical practice. Even then, the application of that knowledge is “highly uneven.”

• A recent study in the New England Journal of Medicine found that only about half of all patients received the care they should be getting according to established care guidelines—with the rest receiving care no longer considered optimum.

• A study based on state statistics, compiled by the Institute of Medicine, estimates that there are between 44,000 and 98,000 fatalities due to medical errors annually in U.S. hospitals.

Well-informed patients put pressure on doctors to keep track of new medical developments, and evidence-based medicine guidelines represent the latest knowledge.

Though business gurus have for years been touting the importance of “best practices” in running companies, the concept is now also gaining traction in the health care industry with numerous quality initiatives and a move toward evidence-based medicine or EBM.

Evidence-based medicine is the explicit use of best evidence—the most current and reliable research—in making decisions about the care of individual patients, according to the U.K.–based Centre for Evidence Based Medicine.

“The term EBM refers to a specific paradigm that’s based more on statistical research,” says Dr. David Frenz, who practices at St. Joseph’s Hospital in St. Paul. “EBM looks at multiple randomized clinical trials and when the results agree, clinical practice guidelines can be created for care that should be done for certain groups of patients.”

These guidelines will in turn help reduce errors by advocating consistent procedures, expose patients to less risk because they receive only care that’s known to work, and lower costs in part by employing the most effective treatments once, rather than less effective treatments multiple times.

The increasing availability of credible medical research is helping evidence-based medicine win acceptance. In addition, current trends handing consumers a larger role in managing their own health care (through health saving accounts in particular) are playing a role. Such consumers often do significant research on health conditions and treatment options, and discuss their research with their doctors. Well-informed patients put pressure on doctors to keep track of new medical developments, and evidence-based medicine guidelines represent the latest knowledge.

Dr. George Isham, medical director and chief health officer at HealthPartners, a health care provider and insurer based in Bloomington, notes that he could not practice medicine today with only his now-outdated medical school education and without more recently acquired knowledge. He says evidence-based medicine guidelines help keep doctors up to date.