Hi Susan, and group
Susan, I think you have been set a very difficult task.
Sure you could find examples where EBP has apparently contributed to improvements in care. There are papers describing the changes in asthma management and outcomes associated with the British Thoracic Society guidelines going back 20 years, and improvements in CV treatments contributing (but only contributing) to reductions in CV mortality and morbidity.
But of course it's immediately obvious I hope that teasing out the effect of EBP from multiple other changes in population health and in health care delivery is extremely difficult, if not usually impossible.
It's probably more helpful to think of EBP as a social movement. "Evidence" is now part of the cultural approach to health care in many parts of the world - in the UK I think we often underestimate that change, and the variation in care has imperceptibly reduced; you don't see people getting antibiotics, paracetamol, a decongestant etc for a cold anymore because we follow unconsciously the evidence that they don't do any good. But we don't really measure that change and demonstrate that EBP "works". It's an integral part of learning at undergrad, in postgrad training and in lifelong learning.
My other point about social movements is that there's a moral aspect. What would you like clinicians to use in advising about the best management options? The best available scientific evidence or something else? Again you'll find that memorably and comically written about in a Christmas BMJ. It would be equally hard to look for "evidence" that abolishing slavery "works", or that teaching medical students anatomy "works" of course.
Where you might find more rich seams of harder data is in the described variable quality of the many guidelines produced by organisations. They are often doing what they think is a useful act but unfortunately end up with the collective biases of experts rather than following the well defined processes to reduce them to the minimum. And then there's the problem that human beings don't make decisions by blindly following what other people tell them. Lots of people have written about that including me. To say nothing of the impossible task of keeping up with even the volume of the guidelines (for generalists especially). Look for Slawson and Shaughnessy and information overload / mastery.
So looking for guidelines being followed isn't, with respect, the right question. The cultural influence is much greater and realistic than the linear expectation of cause and effect.
But good luck. And I wouldn't want this brief note to gloss over the limitations of EBP and the fact that its fans (of which I'm one) would like to see better and more even implementation of the best available evidence. Simply asking the question is always useful.
Best wishes
Neal
Neal Maskrey
Consultant Clinical Adviser, NICE
Honorary Professor of Evidence-informed decision making, Keele University, Staffordshire.
On 11 Mar 2014, at 23:56, "Klawansky, Susan" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Hello – I’m brand new to this list; please excuse if this topic has been discussed before.
I’m a librarian at a pediatric tertiary care hospital and have been asked to locate evidence that using evidence to practice medicine is actually beneficial - improves outcomes, lowers costs, lowers length of stay, etc. More specifically, my requestor mentioned the fact that so many medical societies have gotton into the guideline business and he wonders if adherence to these guidelines is really having a positive impact on health care.
He intends to use this information to give a talk at a conference, so he’s looking for broadly based studies, across big populations or many institutions, rather than narrowly focused studies from which it would be harder to draw big conclusions.
Of course I'll search the usual databases. But outside of journal literature, I wonder if anyone is aware of studies/reports which have looked at EBP in a broad way and assessed its impact.
Thanks very much.
Susan
Susan Klawansky, MLS, AHIP
Librarian | Library & Information Commons
Seattle Children's
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