Transcript Slide 1

The appraisal and assimilation of
scientific evidence, and its
application to patient care: A key
competency in the design of the
professional curriculum
Robert H. Roswell, M.D.
Senior Associate Dean and Professor of
Medicine, College of Medicine
Professor of Health Administration and Policy,
College of Public Health
Why EBM?



Managing the medical knowledge
explosion
Improving patient safety and quality
Controlling health care costs and
enhancing efficiency
Explosion of Medical Knowledge
Amount of Medical
Literature
2007
1850
1900
1950
Year
2000
2050
Can we continue to use a
traditional approach to train
physicians in view of this growth?
NO!
To Err is Human

44,000 to 98,000 deaths occur in the
United States each year due to
preventable medical errors.
- Institute of Medicine, 1999
Building a Better Delivery
System

“an estimated thirty to forty cents of
every dollar spent on health care… a
half trillion dollars a year… is spent on
costs associated with: overuse,
underuse, misuse, duplication, system
failures…and inefficiency.”
- Institute of Medicine, 2005
Efficiency and Value in Health
Care

“Use evidence more effectively in
decisions by care givers and patients…
(to increase appropriate use and
decrease misuse and overuse)”
- Harvey Fineberg, President, IOM
21st Century Medicine

Physicians must understand "what
works, why it works and who it works
for."
-HHS Secretary Mike Leavitt, Sept. 20, 2007
ACGME General Competencies






Patient Care
Medical Knowledge
Practice-based Learning and
Improvement
Interpersonal and Communication Skills
Professionalism
Systems-based practice
ACGME General Competencies






Patient Care
Medical Knowledge
Practice-based Learning and
Improvement
Interpersonal and Communication Skills
Professionalism
Systems-based practice
Practice-based Learning and
Improvement: required skills





Analyze own practice for needed
improvements
Use of evidence from scientific studies
Application of research and statistical
methods
Use of information technology
Facilitate learning of others
Towards Evidence Based Medicine





Access to relevant literature
Critical evaluation of quality of evidence
Meta-analysis
Formulation of EBM Guidelines
Incorporation of EBM into Health
Information Systems
JAMA. 2005;293:1223-1238.


Effects of Computerized Clinical
Decision Support Systems on
Practitioner Performance and Patient
Outcomes
Amit X. Garg, MD; Neill K. J. Adhikari, MD;
Heather McDonald, MSc; M. Patricia RosasArellano, MD, PhD; P. J. Devereaux, MD;
Joseph Beyene, PhD; Justina Sam, BHSc; R.
Brian Haynes, MD, PhD
JAMA. 2005;293:1223-1238.

Methods

We included English-language randomized
and nonrandomized trials with a
contemporaneous control group that
compared patient care with a CDSS to
routine care without a CDSS and evaluated
clinical performance (ie, a measure of
process of care) or a patient outcome.
JAMA. 2005;293:1223-1238.

Results

From 3997 screened citations, we retrieved
226 full-text articles, and 100 trials met our
criteria for review.
JAMA. 2005;293:1223-1238.

Results
Practitioner performance improvement





Overall
Diagnostic systems
Reminder systems
Disease management
Drug-dosing or prescribing
64%
40%
76%
62%
66%
JAMA. 2005;293:1223-1238.

Conclusions

Many CDSSs improve practitioner
performance, however their effects on
patient outcomes are less clear.
Summary



EBM will be essential to successfully
manage the continued rapid growth of
medical literature
EBM must be an integral part of
physician training
EBM offers great promise to improve
care delivery and patient outcomes,
while reducing health care costs