Health Affairs, 24, no. 6 (2005): 1559 doi: 10.1377/hlthaff.24.6.1559 © 2005 by Project HOPE	New Online   Pay Cuts For Medicare Docs   Access To Care Woes   Public Coverage More Efficient   Empowering Consumers

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Using Evidence

PROLOGUE

Reforming Medical Practice Using Evidence

In fact, as Eddy tells us, several factors contributed to the debunking of this long-held maxim and accelerated the salience and acceptance of EBM. Among these was John Wennberg’s initial work on practice-pattern variations, the discrepancy between actual clinical practice and the lessons of clinical research, and the dearth of evidentiary rationale underpinning the recommendations of often influential informal practice guidelines. And in addition to such environmental drivers, in the face of years of budget-busting health spending increases came the realization that some other model more reliant on actual evidence of efficacy must be applied to guide medical care and coverage decision making if we are ever to reap health outcomes commensurate with the massive scale of the U.S. national investment in health care.

The papers in this section resonate with the ascendant and relentless drumbeat spurring the cause of true evidence-based health care decision making, by proposing innovative elements of reform to hospital-based patient care and clinical trial reporting. First, Alice Gosfield and James Reinertsen describe the six evidence-based "planks" of the increasingly popular 100,000 Lives Campaign, whose immediate application in the hospital setting carries the potential of avoiding upward of 100,000 hospital-related deaths annually, the authors assert. Next Rodney Hayward, David Kent, Sandeep Vijan, and Timothy Hofer identify the important shortcomings of the current and dominant model of clinical trial reporting, including a lack of nuance in identifying potential subgroups at risk for harm by a particular treatment and underestimation of future benefit to other populations. In its place, these authors propose adoption of a more sensitive, risk-stratified approach that is better equipped to negotiate such variables and risks.

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