Clinicians for a long time have incorporated the reading of medical literature into their practice as members of the healthcare community. The time required to sift through data, however, has not uniformly translated into the best outcomes in terms of patient care and satisfaction in individual cases, and often practitioners have resorted to relying on their own clinical experiences and personal judgment.
Evidence Based Medicine (EBM) offers an alternative that allows clinicians to stay current on best practices in the medical industry through the use of evidence-based, standardized protocols.
Evidence-based medicine is a clinical learning strategy that focuses on high-quality research in order to make decisions about patient care on an individual basis. Although the term was coined in the 1980s at McMaster Medical School in Canada, the conceptual approach has continued evolving during the past few decades during its use within health systems.
Because physicians have limited time available for looking through data when confronted with a clinical problem – or a patient with a specific condition – the EBM process guides them to reading literature related to specific issues as they arise rather than a periodic, and often haphazard, review of general databases and scientific journals. Medical practitioners then take into account clinical expertise, patient values, and the best available evidence when deciding on the optimal diagnostic or therapy procedure for their patient.
The EBM approach is often considered a ground-up method: As clinicians learn new evidence for an individual case, their overall body of medical knowledge expands. Within the healthcare community, this can lead to improved quality of care, increased patient satisfaction and reduced costs – the industry’s three main objectives.
Steps within the process
According to New York University’s Ehrman Medical Library, EBM “asks questions, finds and appraises the relevant data, and harnesses that information for everyday clinical practice.” There are generally five steps to be followed in the process. These steps include formulating a clear, answerable clinical question from a specific patient’s condition; searching the literature for relevant clinical articles and the best evidence; evaluating the evidence for its validity; implementing useful findings in clinical practice; and then assessing the results or the performance of the evidence.
Clinical evidence used in this approach often is categorized and ranked based on how detached it is from various the biases that sometimes plague medical research. In a scholarly article about EBM and new challenges and approaches, published in the Acta Inform Medica journal and provided online through the U.S National Library of Medicine, authors Masic et al rank the categories as follows:
1. Evidence obtained by meta-analysis of a variety of randomized controlled research (RCR), followed by evidence from only one RCR.
2. Evidence from well-designed controlled research, followed by evidence from one case of quasi-experimental research.
3. Evidence from non-experimental studies, such as comparative research and case studies.
4. Evidence from experts and clinical practice.
Health practitioners can gather data from a variety of sources. Fortunately, most resources – including the Cochrane Library, PubMed, and numerous government-managed medical libraries – are available online in the form of one or more evidence-based databases.
Sharing knowledge on a global scale
The advent of online resources and advances in communications and information technology mean practitioners now have access to a rich, worldwide body of medical evidence that they can then apply to their local situations. Not only does this lead to greater transparency and accountability through the peer-review process, but practitioners no longer have to trust only their own judgment in a given situation.
That being said, the EBM approach is not about a cookbook style application of medical information. Carolyn Clancy and Kelly Cronin note in an article in the Health Affairs journal that clinicians “must tailor scientific information derived from population-based studies to individual patients’ needs and preferences, and policymakers must identify which approaches are most likely to succeed in their programs.” After all, health care involves diverse populations and individuals with specific values and desires, which makes decision-making all the more complex.
EBM still is not overwhelmingly used in the medical industry, a gap that is attributed to several factors, including limited resources, poor accessibility and the lack of systems approach to improvement. The study by Masic et al encourages the “EBM-oriented clinicians of tomorrow” to address these issues by pursuing three tasks: using evidence summaries in clinical practices; helping to develop and update selected systematic review and/or evidence-based guidelines in their area(s) of expertise; and enrolling patients into studies of diagnosis, prognosis and treatment on which medical practices is based.
As EBM continues to evolve and its infrastructure is strengthened, the approach has the currently untapped potential to make administration of health services more efficient, safer and a greater value to patients.