What can we do to support evidence-based care?

In my studies in my Master’s in Health Administration (MHA) program, we frequently discuss the importance of using evidence-based practices.  However, the reality is, as future administrators, we will never be in the exam room determining which tests and procedures patients should receive.  We can work tirelessly to attempt to influence legislation that rewards providing quality care and calculate the costs generated from overtreatment (which was between $158 billion and $226 billion in 2011)1, but the place where all these efforts either succeed or fail is in physician-patient encounters.

I was talking to a friend recently about healthcare in the U.S.  While we were discussing the high cost of care, she replied by saying that at least we have the best healthcare in the world.  It wasn’t until I quoted the Commonwealth Fund’s 2017 publication on how poor U.S. outcomes are compared to other high-income nations2 that she believed that her understanding was not true.  This is a well-educated, typically well-informed friend who had no idea that the care we receive in America is anything less than the best.  Her defense was that we have the newest and best technology and amazing research, so we have to be the best.  But, as we all know, that is wrong.

My friend, like many, assumes that when her doctor recommends a treatment, it is the best and likely only option. What she doesn’t realize is that some studies estimate as little as half of care in the U.S. is sufficiently supported by evidence3.

Physicians agree that they are the in the best position to address the problem of unnecessary tests and procedures.  According to a survey conducted in 2014 by the ABIM foundation, 58 percent of physicians responded that they are in the best position to fix the problem.  The same survey revealed that 73 percent of physicians say that unnecessary tests and procedures is a serious problem in American healthcare, but 72 percent believe that the average medical doctor prescribes an unnecessary test or procedure at least once per week4.

So, what is the role those of us who are in the non-patient-facing side of healthcare have to play in this?  We must act to ensure that physicians are supported in delivering evidence-based treatment.  The same AIBM report revealed physicians’ top four proposed solutions to the evidence-based practice problem are malpractice reform (91 percent), having specific, evidence-based recommendations that physicians can use with patients (85 percent), having more time with patients to discuss alternatives (78 percent), and changing the system of financial rewards physicians receive (61 percent).  Each of these are administration or policy-related in some way.  It is up to those of us in that realm to do our part, so physicians can do theirs.

Another barrier in making evidence-based practice the norm is the lag in implementing evidence-based treatment into practice, which is often cited as a 17-year process5.  The field of implementation science is aimed at translating scientific research findings into practice.  Helping to plan for successful implementation, supporting continuous quality improvement efforts, and including implementation science initiatives in the policymaking realm are some additional ways in which those of us in non-clinical sectors of healthcare can aid in making evidence-based practice a smoother adoption process for physicians.

Patients, like my friend, should be able to maintain their trust that medical care in the U.S. is effective.  They shouldn’t have to worry that they are receiving unnecessary treatment, but they should also be educated on how to ask questions about their treatment.  The Choosing Wisely campaign has succeeded in providing patients with this education, but there is still a long way to go in helping patients in this realm.

Physicians are clearly the executors in making evidence-based care decisions.  However, physicians are constantly burdened with competing demands that prevent or inhibit them from adding another conversation to their already-limited patient appointment time.  It is up to those of us who are not in a clinical setting to give physicians the necessary support to provide proper, less wasteful treatment and to improve outcomes along the way.

 

  1. Health Policy Brief: Reducing Waste in Health Care (2012). Health Affairs, retrieved from: https://www.healthaffairs.org/do/10.1377/hpb20121213.959735/full/
  2. Schneider, E., Sarnak, D., Squires, D., Shah, A., & Doty, M. (2017). Mirror, Mirror, 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care.  The Commonwealth Fund, retrieved from: http://www.commonwealthfund.org/interactives/2017/july/mirror-mirror/
  3. McGlynn, E.A., Asch, S.M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E.A. (2003). The quality of health care delivered to adults in the United States.  New England Journal of Medicine, 348(66), 2635-45, retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/12826639
  4. Unnecessary Tests and Procedures in the Health Care System: What Physicians Say About the Problem, the Causes, and the Solutions (2014), retrieved from: http://www.choosingwisely.org/wp-content/uploads/2015/04/Final-Choosing-Wisely-Survey-Report.pdf
  5. Morris, Z., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: understanding time lags in translational research.  Journal of the Royal Society of Medicine, 104, 510-520, retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241518/pdf/JRSM-11-0180.pdf

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