Friday, August 26, 2005

A Little Good News About Evidence-Based Medicine

The Wall Street Journal recently reported (see free link here) about the increasing use of techniques based on evidence-based medicine (EBM) by organizations who pay for medical care in the US. The article focused on the efforts by the Kaiser Permanente managed care organization. As best as I can tell, this organization may actually be doing something that at least approximates a true evidence based process.
My working definition of EBM "making medical decisions based on a systematic search for, and then systematic, critical review of the best evidence available from clinical research." EBM involves considering clinical experience and the clinical context on one hand, and the patient's values, on the other hand, when making such decisions.
There are a variety of frameworks available for teaching and applying the principles of EBM. I like to use the original Users Guides first published by JAMA (available free here). There are several formal definitions of evidence-based medicine, (for example, see this link), and good web-based resources, for example, see this site at Oxford, this site at Sheffield, and its guide to web-based resources.
Of course, there are concerns that any time a managed care organization says it is using EBM, it really is trying to use evidence selectively to cut costs. The Journal article noted that the American Medical Association (AMA) had accused some state Medicaid programs of doing exactly that. Furthermore, in my humble opinion, if costs are the issue, it might be better to use EBM and principles of medical decision making (as promoted by the Society for Medical Decision Making) to decide how much a particular test or treatment might be worth, rather than simply making up/down decisions about whether to use that treatment at all. But it looks like what Kaiser is doing might be a step in the right direction.

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