Evidence-based medicine (EBM)

      Evidence-based medicine (EBM), previously translational medicine, can be defined as improving care based on empirical research and/or hands-on practice. The EBM’s approach is based on either direct patient care (bottom-up) or an experiment translated into guidelines (top-down). EBM is used in either in conjunction or as quality assessment tool(s) for continuous quality improvement (CQI). The healthcare leader must utilize the evidence to promote healthcare quality. Explain the process of evidence-based analysis. Highlight the major players and their roles in EBM policy (i.e., government, providers, patients, etc.). Explain the EBM “Levels of Evidence” as defined in your course text. Review the case “Constraints of the ACA on Evidence-Based Medicine.” Provide a written analysis of the case “Constraints of the ACA on Evidence-Based Medicine” in Chapter 9 of your textbook. (Utilize the “Levels of Evidence and Grades of Recommendations” as defined by the University of Minnesota) Clearinghouse. Summarize the policy of EBM in your conclusion. Chapter 9 The Policy Analysis Process: Evidence-Based Medicine Evidence-based medicine is not a new concept, but its use is increasingly widespread. The concept has many labels, including evidence-based practice and a more recent offshoot, translational medicine. The term has been attributed to Dave Sackett and his clinical epidemiology colleagues at McGill University, who presented it in a series of 1980 articles in a Canadian journal. In a 1996 article, they presented a revised definition, stating that evidence-based medicine is “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett et al., 1996). Evidence-based medicine can be implemented as a top-down or bottom-up approach, and this difference can lead to considerable confusion. With the top-down approach, experts form a consensus based on strong empirical evidence, and that consensus is then disseminated as standard guidelines and protocols. With the bottom-up approach, a provider deals directly with the patient, identifying the problem and searching for the best evidence about what to do next. Even when strong, evidence-based protocols are available, the bottom-up process can take into account patient variability, patient preferences and situational factors, and the provider’s expertise. The provider’s expertise may be based on evidence or experience, but usually a combination of both leads to better outcomes. Resistance to evidence-based medicine often stems from providers’ fears that the top-down approach will deprive them of their autonomy. A further concern is that the top-down approach may be based on statistical analyses involving homogeneous populations and will not be aligned with the needs of the specific patient. For example, randomized clinical trials may select a homogeneous population without secondary diagnoses, whereas many patients typically presenting in a practice will have multiple conditions. Sackett et al. (1996) addressed these concerns by stating: Evidence-based medicine is not “cookbook” medicine…. External evidence can inform, but can never replace, individual clinical expertise, and itis this expertise that decides whether the external evidence applies to the individual patient at all, and if so, how it should be integrated into a clinical decision. (p. 317) Some providers also are concerned about requiring evidence-based practices for diagnoses, procedures, technologies, and professional settings when there is not an adequate body of research from which to draw conclusions. In medicine, research is often funded by drug and device manufacturers, but it is much more difficult to find funds for research in areas such as mental health, public health, and social services. Policy makers are reluctant to pay for unproven interventions and often are tempted to mandate that programs be evidence based. Such requirements can tie the hands of service providers who must rely on expert opinions unless and until robust research becomes available. Public health, for example, has long believed in the importance of inspecting food establishments, but because foodborne illnesses largely go unreported and public health research is poorly funded, it is difficult to measure the overall effectiveness of restaurant inspections, much less compare the value of different regulatory practices.