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5 Reasons the Practice of Evidence-
Based Medicine Is a Hot Topic
© 2014 Health Catalyst
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5 Reasons the Practice of Evidence-Based Medicine Is a Hot Topic

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Evidence-based medicine is an important model of care because it offers health systems a way to achieve the goals of the Triple Aim. It also offers health systems an opportunity to thrive in this era of value-based care. In specific, there are five reasons the industry is interested in the practice of evidence-based medicine: (1) With the explosion of scientific knowledge being published, it’s difficult for clinicians to stay current on the latest best practices. (2) Improved technology enables healthcare workers to have better access to data and knowledge. (3) Payers, employers, and patients are driving the need for the industry to show transparency, accountability, and value. (4) There is broad evidence that Americans often do not get the care they need. (5) Evidence-based medicine works. While the practice of evidence-based medicine is growing in popularity, moving an entire organization to a new model of care presents challenges. First, clinicians need to change how they were taught to practice. Second, providers are already busy with increasingly larger and larger workloads. Using a five-step framework, though, enables clinicians to begin to incorporate evidence-based medicine into their practices. The five steps include (1) Asking a clinical question to identify a key problem. (2) Acquiring the best evidence possible. (3) Appraising the evidence and making sure it’s applicable to the population and the question being asked. (4) Applying the evidence to daily clinical practice. (5) Assessing performance.

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5 Reasons the Practice of Evidence-Based Medicine Is a Hot Topic

  1. 1. 5 Reasons the Practice of Evidence- Based Medicine Is a Hot Topic
  2. 2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. What Is Evidence-Based Medicine? Imagine you’re a provider caring for a stage II prostate cancer patient. Naturally, you want to choose the treatment to provide the best outcome possible. He is 84 with no visible symptoms. What course of action is best? Evidence-based medicine can guide you and your patient to the most appropriate treatment.
  3. 3. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. What Is Evidence-Based Medicine? Evidence-based medicine includes three key components: Research-based evidence Clinical expertise Patient’s values and preferences
  4. 4. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. What Is Evidence-Based Medicine? Practicing evidence-based medicine offers clinicians a way to achieve the Triple Aim’s objectives: Improved quality Improved patient satisfaction Reduced costs
  5. 5. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. What Is Evidence-Based Medicine? Using evidence-based medicine, a provider can assess the evidence as well as the risks and benefits of ordering diagnostic tests and treatments for patients. Providers can then better predict whether a treatment will do more harm than good.
  6. 6. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. What Is Evidence-Based Medicine? As reported in this article: Using evidence-based medicine “help[s] physicians provide more rational care with better outcomes.”
  7. 7. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. What Is Evidence-Based Medicine? Evidence-based medicine encourages a dialogue between patients and their provider, so patients can share in decision- making and make their values and preferences known. Patients feel their doctors are listening to their concerns and taking those concerns into consideration when determining the treatment plan.
  8. 8. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Components of Evidence-Based Medicine
  9. 9. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Reasons the Practice of Evidence-Based Medicine Adds Value to Health Systems With so much scientific knowledge being published, it’s difficult for clinicians to stay current with latest medical practices. A primary care physician would need to read 17 articles a day, 365 days a year to stay current. Using standard evidence-based protocols, providers can achieve this impossibility. 1 Staying Current
  10. 10. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Reasons the Practice of Evidence-Based Medicine Adds Value to Health Systems Healthcare workers now have much better access to data and knowledge because of improved technology like electronic medical records (EMRs), data warehouses, and sophisticated analytics. Evidence-Based Decision Making: Global Evidence, Local Decisions 2 Improved access to data
  11. 11. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Reasons the Practice of Evidence-Based Medicine Adds Value to Health Systems Payers, employers, and patients are driving the need for the healthcare industry to show transparency, accountability, and value. Practicing evidence-based healthcare can help the industry achieve these goals. 3 Improve transparency
  12. 12. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Reasons the Practice of Evidence-Based Medicine Adds Value to Health Systems Although the U.S. spends more money per person on healthcare than any other nation in the world, there is broad evidence Americans often do not get the care needed. With evidence-based medicine, care improves because clinicians have access to data previously untapped and best practices vetted and agreed upon by peers. 4 Data use improves care
  13. 13. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Reasons the Practice of Evidence-Based Medicine Adds Value to Health Systems The most important reason for the interest in evidence-based medicine is that it works. As demonstrated with 15 case studies in the publication Evidence Based Medicine Matters, the use of evidence-based medicine resulted in improvements ranging from quicker recovery times after surgical procedures to safer ways to deliver breech babies. 5 It works!
  14. 14. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Future of Evidence-Based Medicine The acceleration of the value- based payment movement will continue in the years ahead. Opportunities for improvement using evidence-based medicine are driving excitement in today’s healthcare systems. Patients gain confidence that they are getting the best care possible because treatments are based on the most current medical knowledge.
  15. 15. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care The five steps of evidence-based medicine include the 5 As: ask, acquire, appraise, apply, and assess.
  16. 16. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care The first step in moving to evidence- based care is to form teams of clinicians whose role is to ask questions to identify the critical few problems that need to be addressed. When choosing a problem to focus on, it’s important to identify a high- priority problem that offers a significant return on investment. 1 Ask a clinical question
  17. 17. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care Some questions clinicians can ask to help identify problems include Why are we practicing this way? Are we adhering to best practices? Can we produce better outcomes? 1 Ask a clinical question
  18. 18. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care To help clinicians rank quality between evidence sources David Sackett, MD, popularized the evidence-based medicine pyramid. Four levels of evidence: Most desirable at top 2 Acquire the best evidence
  19. 19. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care Level I: Evidence in Level I is considered the gold standard of medical knowledge because it comes from randomized controlled clinical trials (RCTs). Level I RCTs enable the results from a clinical trial to be “free from any bias that might otherwise be introduced by the people involved.” 2 Acquire the best evidence
  20. 20. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Level II evidence comes from three different sources: • Controlled trials without randomization • Cohort or case-control analytic studies • Multiple time series studies 5 Steps to Move to an Evidence-Based Model of Care Level II: Evidence in Level II is not considered quite as reliable as evidence from Level I, but better then III and IV. 2 Acquire the best evidence Level II-1 Level II-2 Level II-3
  21. 21. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care Level III: Evidence in Level III is based on expert opinion, in particular, from experts who’ve narrowed their focus as much as possible about a complex area. 2 Acquire the best evidence Level III The downside is that sample sizes are usually too small and there aren’t any control groups. This leaves a large margin for error unless group statistical techniques are used to compile the opinions of a large number of experts.
  22. 22. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care Level IV: “Evidence” in Level IV is based on personal experience. This is the least desirable source of evidence and lacks any statistical validity. 2 Acquire the best evidence Level IV
  23. 23. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care There’s good evidence (RCTs) and there’s bad evidence (e.g., from personal experience). Then there’s evidence that falls in the gray area—neither clearly defined as good nor bad. It can be difficult for clinicians to know whether or not to use evidence in the gray area. 3 Appraise the evidence
  24. 24. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care Questions clinicians can ask when appraising evidence: 3 Appraise the evidence Does the evidence improve decision-making or outcomes? Does the evidence improve clinical quality or patient safety? Does the evidence improve efficiency and lower costs? Does the evidence improve the care experience? Does the evidence improve access to healthcare services?
  25. 25. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care If the evidence passes the appraisal step and adds value to the practice of medicine, then clinicians can incorporate the new knowledge into their daily clinical practice. Since not all clinicians will understand the value of adopting a new standard of care, it’s essential to communicate the change and the benefit it adds to patient care. 4 Apply the evidence
  26. 26. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. 5 Steps to Move to an Evidence-Based Model of Care Lastly, assess any improvements to performance or outcomes the new evidence provides. This can be accomplished by establishing a baseline and then measuring improvements. Ongoing reassessment, measuring any gains or losses, should be part of an ongoing cycle to ensure the best outcomes. 5 Assess your performance
  27. 27. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Key Takeaways Evidence-based medicine includes three key components: 1. Research-based evidence 2. Clinical expertise 3. Patients’ values and preferences
  28. 28. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Key Takeaways Interest in the practice of evidence- based medicine is high for five reasons: 1. Staying current on knowledge 2. Improved access to data 3. Improved transparency 4. Americans not getting needed care 5. Evidence-based medicine works
  29. 29. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Key Takeaways The five steps of evidence-based medicine: 1. Ask a clinical question 2. Acquire the best evidence possible 3. Appraise the evidence and make sure it’s applicable 4. Apply the evidence 5. Assess your performance
  30. 30. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Introducing the Accelerated Practices (AP) Program: Dr. John Haughom, Dr. Bryan Oshiro, and Sherry Martin Health Catalyst Academy: An Innovative Approach for Accelerating Outcomes Improvement Dr. John Haughom – Senior advisor The Rising Healthcare Revolution: The Future Is Already Here Dr. John Haughom – Senior advisor Planning for Healthcare Improvement: A Goal Without a Plan Is Just a Wish Dr. John Haughom – Senior advisor Preventable Medical Errors: The Future is Calling Us Dr. John Haughom – Senior advisor Link to original article for a more in-depth discussion. Five Reasons the Practice of Evidence-Based Medicine Is a Hot Topic
  31. 31. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information:
  32. 32. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. John Haughom, MD is an experienced healthcare executive with proven expertise in technology-enabled innovation, developing results-oriented strategic plans, leading multifaceted organization-wide change, and directing complex operations. He has a strong record of turning vision into effective strategies and successfully implementing initiatives resulting in value including higher quality, safer care at the lowest possible cost. His broad knowledge of healthcare and emerging healthcare technologies is coupled with his recognized leadership abilities, strong communication skills, and demonstrated ability to contribute to organizational goals such as improved clinical outcomes, lower costs, improved access to care, and increased profitability. After practicing for 15 years as an internist and gastroenterologist, Dr. Haughom assumed a senior executive role with responsibilities for system-wide automation, budgeting, customer support, database administration, healthcare delivery, information technology, quality control, research, safety, and strategic planning. Dr. Haughom became President and CEO of a firm focused on health care transformation through consulting, strategic planning, mentoring inexperienced physician leaders, involvement in regional and national reform movements, membership on boards of leading edge organizations committed to improving the value of healthcare, and partnership with other like-minded organizations with similar aspirations and goals. As Senior Vice President of Clinical Quality and Patient Safety for the premiere health care system in the Northwest spanning three states (Oregon, Washington and Alaska), Dr. Haughom developed and implemented a system-wide quality improvement strategy, comprehensive patient safety plan, and comprehensive system-wide information technology strategy. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com

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