The best medicine: Adopting evidence-based practice
Thomas Meehan, MD, MPH, Executive Director, Connecticut Center for Primary Care
Science makes progress at a brisk pace. It feels safe to assume that as medicine advances and better methods are revealed, they are rapidly incorporated into practice. Unfortunately, moving research from the lab to the bedside can be surprisingly slow going.
A notable example of this delay was found by the Agency for Healthcare Research and Quality in 2005. They reported that the evidence-based practice of giving beta-blockers to post-myocardial infarction patients took 25 years to reach eighty-five percent of patients.1
Fortunately, dissemination of innovation is well researched and methods for improving are clear.
Passive vs. active diffusion
Evidence shows that moving new ideas from concept to practice in a timely way requires action. “Passive diffusion,” the unfacilitated movement of evidence-based principles from study to practice, makes for delayed distribution of evidence.
Far preferable is “active diffusion,” requiring effort on the part of providers to seek out and trial new approaches.2 Awareness of this phenomenon pushes practitioners to establish systems of revising and amending practice.
The role of evidence in value creation
Examples of successful adoption of evidence-based practice through “active diffusion” can be found in select large, integrated health systems. The Mayo Clinic publishes extensively on their work to incorporate high-value practices.
Mayo’s “Value Creation System” assigns responsibilities to clinical practice committees, management, and front-line staff in the creation and implementation of new clinical guidelines.
The four-step ongoing process first selects a target area for improvement (alignment), then assigns the committee to research and create the new guideline (discovery).
Next the implementation of the guideline (managed diffusion) is carried out with needed training or retraining of providers plus support and resources from management. Throughout the implementation, data is collected so that changes and improvement can be monitored (measurement).3
This highly structured method of adoption yields financial and clinical rewards for the provider, and more importantly ensures quality patient care.
In 2010, Mayo Clinic approved a new guideline to standardize administration practice for the high-risk medication Warfarin. Initial data showed 3.5 percent of patients treated with Warfarin experienced a defect, or undesirable outcome.4
Recognizing this variation lead to discovery efforts by the clinical practice committee and subsequent creation of a new evidence-based guideline. Staff were retrained and the information technology infrastructure was updated to make sure that “doing the right thing was the easy thing.”5
Metrics checked the efficacy of the new guideline. Data collection showed defect rates for Warfarin had been reduced to 1.5 percent.6 The final stage of Mayo’s evidence based practice diffusion method “Value Creation System” is publication of findings.
Anticipating that findings will be scrutinized by the public ensures that every stage — alignment, discovery, managed diffusion and measurement — meets the high standards of scientific rigor.
Investment in innovation
Setting aside time and talent in pursuit of better practices is a proven wise investment. Providers charged with updating guidelines can remove barriers and create incentives for the adoption of evidence-based practice.
Assigning roles for finding, reviewing, implementing and measuring outcomes of new practices engages staff in the advancement of their work. Designating and funding the roles that keep health systems up-to-date creates efficient, high-reliability health care organizations.
When the task of staying current is woven into the fabric of an organization, change and improvement become part of day-to-day work.
The culture of a health care system governs the speed with which it adopts scientifically sound methods. Health care providers are held to increasingly rigorous standards of performance.
Therefore, it is essential to create a culture that actively pursues the most advanced science and continually updates practice and measures results.
An “active diffusion” system for evidence-based practice creates optimal performance by getting rid of wasteful practices unsupported by the evidence while bringing in practices that efficiently produce better outcomes.
Ensuring that the most effective care is given in a reliable and uniform fashion makes for the best clinical and financial outcomes. When a health care organization chooses to deliberately incorporate up-to-date practices, satisfaction for patients, providers and payers is at its best.
- Agency for Healthcare Research and Quality. National Healthcare Quality Report, 2005. http://archive.ahrq.gov/qual/nhqr05/nhqr05.htm. Last updated June 2007. Accessed March 3, 2013.
- Rogers EM. Diffusion of Innovations. New York City: Free Press. 1962.
- Swensen S, Dilling J, Harper Jr C, Noseworthy J. The Mayo Clinic value creation system. American Journal of Medical Quality, 2012; 27(1), 58-65.
The views and opinions expressed herein are those of the authors and do not necessarily represent the views of Optum Care. The views and opinions expressed may change without notice.