Evidence based medicine incorporates the best research evidence with clinician knowledge
and patient's values and preferences. However healthcare providers often fall short.
‘Bridging the quality chasm’ the 2001 report from the US Institute of Medicine (IOM),
highlighted the issues of “overuse, underuse, and misuse” in healthcare [
[1]
]. Of these, the evidence-practice gaps of “underuse” and “overuse” are likely to be
substantial contributors to the preventable burden of harm from poor quality of care
[
[2]
]. Sometimes the gap is due to a failure of implementation. There are numerous examples
where research evidence of benefit has taken years to be adopted in practice (e.g.
crystalloid fluids for shock management). However, most care is delivered as a bundle
where multiple processes all synergistically work towards patient outcomes. A study
by Rayan et al. of 774 randomly selected patients with moderate to severe injuries
admitted to US level one trauma centres, found only 53% of patients who met recognized
clinical criteria received common trauma-specific processes of care [
[3]
]. Using similar methodology, Shafi et al. found that after adjusting for potential
confounders patients who received all recommended care were 58% less likely to die
(OR 0.42; 95% CI, 0.28–0.62) than those who did not [
[4]
].To read this article in full you will need to make a payment
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References
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- Olsen L. Aisner D. McGinnis J.M. The learning healthcare system: workshop summary. National Academies Press, Washington, DC2007
Collaboratory. NHCSR. Learning Healthcare Systems. Rethinking Clinical Trials: A Living Textbook of Pragmatic Clinical Trials. Available at: http://sites.duke.edu/rethinkingclinicaltrials/informed-consent-in-pragmatic-clinical-trials/; 2014 [accessed 04.05.16].
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© 2016 Published by Elsevier Ltd.
