Evidence Based Medicine

Evidence-based medicine is an array of care guidelines, care patterns, and new shared decision-making tools for both caregivers and patients. The cost of healthcare could be reduced by nearly 29 percent and clinical outcomes improved significantly if EBM guidelines and the most efficient care procedures were used by all practitioners. The major EBM tool is the clinical guideline (also known as a protocol), which the Institute of Medicine defines as ” systematically developed statements to assist practitioner and patient decision about appropriate health care for specific clinical circumstances” (Timmermans and Mauck 2005, 18), The cure to the wide variation in health care practice is the consistent application of EBM.

One source for such information is the National Guideline Clearinghouse (2006), a comprehensive database of evidence-based clinical practice guidelines and related documents that contains more than 4,000 guidelines.

Organizations that are outside of the healthcare delivery system itself have used the increased acceptance of EBM as the basis for new programs focused on encouraging increased implementation of EBM. These programs, sometimes called “value purchasing” include:

Public Reporting
Many health plans report performance and the process of providers in their networks to assist their plan members.

Pay-for-performance
In general, P4P systems add payments to the amount that would otherwise be paid to a provider. To obtain these additional payments, the provider must demonstrate that he is delivering care that meets clinical EBM goals.

Tiered systems of care
Tiering is another method being used to encourage the spread of EBM. Tiered systems present health plan members with a number of network or medical clinic options that have variable premiums or copays. The health plan creates the tiers based on quality and cost.