Medical information content vendor Elsevier has published the first in a series of issue briefs examining the benefits and challenges of adopting evidence-based medicine.

The first brief tackles building a business case for evidence-based medicine, based in part on a roundtable discussion of chief medical information officers in the fall of 2012, which defined EBM as “the integration of the best research evidence with clinical expertise and patient values.”

The brief lays out core components of EBM: converting information into a focused question, identifying the best evidence for answering the question, reviewing evidence for validity and clinical usefulness, applying results to clinical practice and evaluating how the evidence performs in clinical applications. “More recently, experts have refined the definition of EBM to include evidence-based policy, review, research and guidelines.”

Rand Corp. has estimated that six categories of waste--overtreatment, failed care coordination, failed execution of care processes, administrative complexity, pricing failures, and fraud and abuse--consumed 37 percent of health care spending in 2011. “EBM can go a long way in reducing health care’s failure to implement preventive and patient safety best practices, which typically result in injuries, negative patient outcomes and runaway costs. It also can minimize the burden of overtreatment, where physicians’ habits and preferences sometimes trump medical evidence. Fearful of liability and malpractice, physicians can easily resort to defensive medicine. Or, they may ‘over diagnose’ a disease, pursuing early treatment in lieu of a more prudent wait-and-watch approach.”

In the brief, Peter Wyer, M.D., chair of the section on evidence-based health care at the New York Academy of Medicine, cautions that today’s EBM has limitations. “Traditional EBM has already contributed methodological rigor and electronic databases. What’s needed is a more complete model for EBM dissemination and diffusion and multiple types of evidence, including evidence from practice settings.”

The issue brief, “Building a Business Case for Evidence-Based Medicine,” is available here.

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