Evidence-based individual decision making: Difference between revisions
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'''Evidence-based individual decision making''' is [[evidence-based medicine]] (EBM) as practiced by the ''individual [[health care provider]] and an individual patient''. This is in contrast to ''Evidence-based guidelines'' which is EBM at the ''organizational or institutional'' level, and involves producing guidelines, policy, and regulations. | '''Evidence-based individual decision making''' is [[evidence-based medicine]] (EBM) as practiced by the ''individual [[health care provider]] and an individual patient''. This is in contrast to ''Evidence-based guidelines'' which is EBM at the ''organizational or institutional'' level, and involves producing guidelines, policy, and regulations. There is concern that current [[evidence-based medicine]] focuses excessively on EBID.<ref name="pmid15647211">{{cite journal |author=Eddy DM |title=Evidence-based medicine: a unified approach |journal=Health affairs (Project Hope) |volume=24 |pages=9–17 |year=2005 |pmid=15647211 |doi=10.1377/hlthaff.24.1.9}}</ref> | ||
There is concern that current [[evidence-based medicine]] focuses excessively on EBID.<ref name="pmid15647211">{{cite journal |author=Eddy DM |title=Evidence-based medicine: a unified approach |journal=Health affairs (Project Hope) |volume=24 | |||
==Classification== | ==Classification== | ||
Evidence-based individual decision making can be divided into three modes: "doer", "user", "replicator" by the intensity of the work by the individual.<ref name="pmid11033714">{{cite journal |author=Straus SE, McAlister FA |title=Evidence-based medicine: a commentary on common criticisms |journal=CMAJ : Canadian Medical Association Journal |volume=163 |pages=837–41 |year=2000 |pmid=11033714 |doi=}}</ref> | Evidence-based individual decision making can be divided into three modes: "doer", "user", "replicator" by the intensity of the work by the individual.<ref name="pmid11033714">{{cite journal |author=Straus SE, McAlister FA |title=Evidence-based medicine: a commentary on common criticisms |journal=CMAJ : Canadian Medical Association Journal |volume=163 |pages=837–41 |year=2000 |pmid=11033714 |doi=}}</ref> This categorization somewhat parallels the theory of [[Diffusion of innovations]], but without pejorative terms, in which adopters of innovation are categorized as innovators (2.5%), early adopters (13%), early majority (33%), late majority (33%), and laggards (16%).<ref name="pmid12697800">{{cite journal |author=Berwick DM |title=Disseminating innovations in health care |journal=JAMA |volume=289 |pages=1969–75 |year=2003 |pmid=12697800 |doi=10.1001/jama.289.15.1969 |issn=}}</ref> This categorization for doctors is supported by a preliminary empirical study of Green ''et al.'' that grouped doctors into Seekers, Receptives, Traditionalists, and Pragmatists.<ref name="pmid12485547">{{cite journal |author=Green LA, Gorenflo DW, Wyszewianski L |title=Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study |journal=Journal of Family Practice |volume=51 |pages=938–42 |year=2002 |pmid=12485547 |doi=|url=http://www.jfponline.com/Pages.asp?AID=1332&issue=November%202002&UID=}}</ref> The study of Green ''et al.'' has not been externally validated. | ||
The same doctors may operate in different modes depending on how much time is available to seek evidence during clinical care.<ref name="pmid12058546">{{cite journal |author=Montori VM ''et al.'' |title=A qualitative assessment of 1st-year internal medicine residents' perceptions of evidence-based clinical decision making |journal=Teaching and Learning in Medicine |volume=14 |pages=114–8 |year=2002 |pmid=12058546 |doi=}}</ref> Medicine residents early in training tend to prefer being taught the practitioner model, whereas residents later in training tended to prefer the user model.<ref name="pmid16707306">{{cite journal |author=Akl EA ''et al.''|title=EBM user and practitioner models for graduate medical education: what do residents prefer? |journal=Medical Teacher |volume=28 |pages=192–4 |year=2006 |pmid=16707306 |doi=10.1080/01421590500314207}}</ref> | |||
The same doctors may | |||
===Doer=== | ===Doer=== | ||
The "''doer''"<ref name="pmid11033714"/> or "''practitioner''"<ref name="pmid10753130">{{cite journal |author=Guyatt GH ''et al.''|title=Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch, but all need some skills |journal=BMJ |volume=320 |pages=954–5 |year=2000 |pmid=10753130 |doi=}}</ref> of evidence-based medicine does at least the first four steps (above) of evidence-based medicine and are performed for "''self-acquired''"<ref name="pmid12058546"/> knowledge. | The "''doer''"<ref name="pmid11033714"/> or "''practitioner''"<ref name="pmid10753130">{{cite journal |author=Guyatt GH ''et al.''|title=Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch, but all need some skills |journal=BMJ |volume=320 |pages=954–5 |year=2000 |pmid=10753130 |doi=}}</ref> of evidence-based medicine does at least the first four steps (above) of evidence-based medicine and are performed for "''self-acquired''"<ref name="pmid12058546"/> knowledge. | ||
If the Doers are the same as the "''Seekers''" in the study of Green, then this group may be 3% of physicians.<ref name="pmid12485547"/> | If the Doers are the same as the "''Seekers''" in the study of Green, then this group may be 3% of physicians.<ref name="pmid12485547"/> This group may also be the similarly small group of doctors who use formal [[Bayesian calculations]]<ref name="pmid9576412">{{cite journal |author=Reid MC ''et al.''|title=Academic calculations versus clinical judgments: practicing physicians' use of quantitative measures of test accuracy |journal=Am J Med |volume=104|pages=374–80 |year=1998 |pmid=9576412 |doi=}}</ref> or [[MEDLINE]] searches<ref name="pmid10435959">{{cite journal |author=Ely JW ''et al.'' |title=Analysis of questions asked by family doctors regarding patient care |journal=BMJ |volume=319 |pages=358–61 |year=1999 |pmid=10435959 |doi=}}[http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=10435959 PubMed Central]</ref>. | ||
This group may also be the similarly small group of doctors who use formal [[Bayesian calculations]]<ref name="pmid9576412">{{cite journal |author=Reid MC ''et al.''|title=Academic calculations versus clinical judgments: practicing physicians' use of quantitative measures of test accuracy |journal=Am J Med |volume=104|pages=374–80 |year=1998 |pmid=9576412 |doi=}}</ref> or [[MEDLINE]] searches<ref name="pmid10435959">{{cite journal |author=Ely JW ''et al.'' |title=Analysis of questions asked by family doctors regarding patient care |journal=BMJ |volume=319 |pages=358–61 |year=1999 |pmid=10435959 |doi=}}[http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=10435959 PubMed Central]</ref>. | |||
===User=== | ===User=== | ||
For the "''user''" of evidence-based medicine, ''[literature]'' searches are restricted to evidence sources that have already undergone critical appraisal by others, such as evidence-based guidelines or evidence summaries"<ref name="pmid11033714">{{cite journal |author=Straus SE, McAlister FA |title=Evidence-based medicine: a commentary on common criticisms |journal=CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne |volume=163 |issue=7 |pages=837–41 |year=2000 |pmid=11033714 |doi=}}</ref>. More recently, the 5S search strategy,<ref name="pmid17080967">{{cite journal |author=Haynes RB |title=Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions |journal=ACP J. Club |volume=145 |issue=3 |pages=A8 |year=2006 |pmid=17080967 |doi=}}</ref> which starts with the search of "summaries" (evidence-based textbooks) is a quicker approach.<ref name="pmid17082828">{{cite journal |author=Patel MR, Schardt CM, Sanders LL, Keitz SA |title=Randomized trial for answers to clinical questions: evaluating a pre-appraised versus a MEDLINE search protocol |journal=Journal of the Medical Library Association : JMLA |volume=94 |issue=4 |pages=382–7 |year=2006 |pmid=17082828 |doi=}}</ref> | For the "''user''" of evidence-based medicine, ''[literature]'' searches are restricted to evidence sources that have already undergone critical appraisal by others, such as evidence-based guidelines or evidence summaries"<ref name="pmid11033714">{{cite journal |author=Straus SE, McAlister FA |title=Evidence-based medicine: a commentary on common criticisms |journal=CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne |volume=163 |issue=7 |pages=837–41 |year=2000 |pmid=11033714 |doi=}}</ref>. More recently, the 5S search strategy,<ref name="pmid17080967">{{cite journal |author=Haynes RB |title=Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions |journal=ACP J. Club |volume=145 |issue=3 |pages=A8 |year=2006 |pmid=17080967 |doi=}}</ref> which starts with the search of "summaries" (evidence-based textbooks) is a quicker approach.<ref name="pmid17082828">{{cite journal |author=Patel MR, Schardt CM, Sanders LL, Keitz SA |title=Randomized trial for answers to clinical questions: evaluating a pre-appraised versus a MEDLINE search protocol |journal=Journal of the Medical Library Association : JMLA |volume=94 |issue=4 |pages=382–7 |year=2006 |pmid=17082828 |doi=}}</ref> | ||
If the Users are the same as the "''Receptives''" in the study of Green, then this group may be 57% of physicians.<ref name="pmid12485547">{{cite journal |author=Green LA, Gorenflo DW, Wyszewianski L |title=Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study |journal= | If the Users are the same as the "''Receptives''" in the study of Green, then this group may be 57% of physicians.<ref name="pmid12485547">{{cite journal |author=Green LA, Gorenflo DW, Wyszewianski L |title=Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study |journal=J Fam practice |volume=51 |pages=938–42 |year=2002 |pmid=12485547 |doi=}}</ref> | ||
Teaching this group management of information resources may be especially important.<ref name="pmid17327723">{{cite journal |author=McCord G | Teaching this group management of information resources may be especially important.<ref name="pmid17327723">{{cite journal |author=McCord G ''et al'' |title=Answering questions at the point of care: do residents practice EBM or manage information sources? |journal=Acad Med |volume=82 |pages=298–303 |year=2007 |month=March |pmid=17327723 |doi=10.1097/ACM.0b013e3180307fed |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?an=00001888-200703000-00016 |issn=}}</ref> | ||
===Replicator=== | ===Replicator=== | ||
For the "''replicator''", "decisions of respected opinion leaders are followed"<ref name="pmid11033714">{{cite journal |author=Straus SE, McAlister FA |title=Evidence-based medicine: a commentary on common criticisms |journal=CMAJ : Canadian Medical Association | For the "''replicator''", "decisions of respected opinion leaders are followed"<ref name="pmid11033714">{{cite journal |author=Straus SE, McAlister FA |title=Evidence-based medicine: a commentary on common criticisms |journal=CMAJ : Canadian Medical Association Journal = journal de l'Association medicale canadienne |volume=163|pages=837–41 |year=2000 |pmid=11033714 |doi=}}</ref>. This has been called "'''borrowed' expertise''".<ref name="pmid12058546">{{cite journal |author=Montori VM, Tabini CC, Ebbert JO |title=A qualitative assessment of 1st-year internal medicine residents' perceptions of evidence-based clinical decision making |journal=Teaching and learning in medicine |volume=14 |pages=114–8 |year=2002 |pmid=12058546 |doi=}}</ref> | ||
If the Replicators are the same as the "''Traditionalists''" and "''Pragmatists''" combined in the study of Green, then this group may be 40% of physicians.<ref name="pmid12485547">{{cite journal |author=Green LA, Gorenflo DW, Wyszewianski L |title=Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study |journal= | If the Replicators are the same as the "''Traditionalists''" and "''Pragmatists''" combined in the study of Green, then this group may be 40% of physicians.<ref name="pmid12485547">{{cite journal |author=Green LA, Gorenflo DW, Wyszewianski L |title=Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study |journal=J Fam Practice |volume=51 |issue=11 |pages=938–42 |year=2002 |pmid=12485547 |doi=}}</ref> This is a very broad group of doctors. Possibly the lowest end of this group may be equivalent to the laggards of Rogers. This much smaller group of doctors, ones who have "severely diminished capacity for self-improvement", may be at increased risk of disciplinary action by medical boards.<ref name="pmid16371633">{{cite journal |author=Papadakis MA ''et al.'' |title=Disciplinary action by medical boards and prior behavior in medical school |journal=N Engl J Med |volume=353 |pages=2673–82 |year=2005 |pmid=16371633 |doi=10.1056/NEJMsa052596 |issn=}}</ref> | ||
==Teaching evidence-based individual decision making== | ==Teaching evidence-based individual decision making== | ||
Revision as of 06:38, 16 January 2009
Evidence-based individual decision making is evidence-based medicine (EBM) as practiced by the individual health care provider and an individual patient. This is in contrast to Evidence-based guidelines which is EBM at the organizational or institutional level, and involves producing guidelines, policy, and regulations. There is concern that current evidence-based medicine focuses excessively on EBID.[1]
Classification
Evidence-based individual decision making can be divided into three modes: "doer", "user", "replicator" by the intensity of the work by the individual.[2] This categorization somewhat parallels the theory of Diffusion of innovations, but without pejorative terms, in which adopters of innovation are categorized as innovators (2.5%), early adopters (13%), early majority (33%), late majority (33%), and laggards (16%).[3] This categorization for doctors is supported by a preliminary empirical study of Green et al. that grouped doctors into Seekers, Receptives, Traditionalists, and Pragmatists.[4] The study of Green et al. has not been externally validated.
The same doctors may operate in different modes depending on how much time is available to seek evidence during clinical care.[5] Medicine residents early in training tend to prefer being taught the practitioner model, whereas residents later in training tended to prefer the user model.[6]
Doer
The "doer"[2] or "practitioner"[7] of evidence-based medicine does at least the first four steps (above) of evidence-based medicine and are performed for "self-acquired"[5] knowledge.
If the Doers are the same as the "Seekers" in the study of Green, then this group may be 3% of physicians.[4] This group may also be the similarly small group of doctors who use formal Bayesian calculations[8] or MEDLINE searches[9].
User
For the "user" of evidence-based medicine, [literature] searches are restricted to evidence sources that have already undergone critical appraisal by others, such as evidence-based guidelines or evidence summaries"[2]. More recently, the 5S search strategy,[10] which starts with the search of "summaries" (evidence-based textbooks) is a quicker approach.[11]
If the Users are the same as the "Receptives" in the study of Green, then this group may be 57% of physicians.[4]
Teaching this group management of information resources may be especially important.[12]
Replicator
For the "replicator", "decisions of respected opinion leaders are followed"[2]. This has been called "'borrowed' expertise".[5]
If the Replicators are the same as the "Traditionalists" and "Pragmatists" combined in the study of Green, then this group may be 40% of physicians.[4] This is a very broad group of doctors. Possibly the lowest end of this group may be equivalent to the laggards of Rogers. This much smaller group of doctors, ones who have "severely diminished capacity for self-improvement", may be at increased risk of disciplinary action by medical boards.[13]
Teaching evidence-based individual decision making
References
- ↑ Eddy DM (2005). "Evidence-based medicine: a unified approach". Health affairs (Project Hope) 24: 9–17. DOI:10.1377/hlthaff.24.1.9. PMID 15647211. Research Blogging.
- ↑ 2.0 2.1 2.2 2.3 Straus SE, McAlister FA (2000). "Evidence-based medicine: a commentary on common criticisms". CMAJ : Canadian Medical Association Journal 163: 837–41. PMID 11033714. [e]
Cite error: Invalid
<ref>tag; name "pmid11033714" defined multiple times with different content Cite error: Invalid<ref>tag; name "pmid11033714" defined multiple times with different content - ↑ Berwick DM (2003). "Disseminating innovations in health care". JAMA 289: 1969–75. DOI:10.1001/jama.289.15.1969. PMID 12697800. Research Blogging.
- ↑ 4.0 4.1 4.2 4.3 Green LA, Gorenflo DW, Wyszewianski L (2002). "Validating an instrument for selecting interventions to change physician practice patterns: a Michigan Consortium for Family Practice Research study". Journal of Family Practice 51: 938–42. PMID 12485547. [e]
Cite error: Invalid
<ref>tag; name "pmid12485547" defined multiple times with different content Cite error: Invalid<ref>tag; name "pmid12485547" defined multiple times with different content - ↑ 5.0 5.1 5.2 Montori VM et al. (2002). "A qualitative assessment of 1st-year internal medicine residents' perceptions of evidence-based clinical decision making". Teaching and Learning in Medicine 14: 114–8. PMID 12058546. [e]
Cite error: Invalid
<ref>tag; name "pmid12058546" defined multiple times with different content - ↑ Akl EA et al. (2006). "EBM user and practitioner models for graduate medical education: what do residents prefer?". Medical Teacher 28: 192–4. DOI:10.1080/01421590500314207. PMID 16707306. Research Blogging.
- ↑ Guyatt GH et al. (2000). "Practitioners of evidence based care. Not all clinicians need to appraise evidence from scratch, but all need some skills". BMJ 320: 954–5. PMID 10753130. [e]
- ↑ Reid MC et al. (1998). "Academic calculations versus clinical judgments: practicing physicians' use of quantitative measures of test accuracy". Am J Med 104: 374–80. PMID 9576412. [e]
- ↑ Ely JW et al. (1999). "Analysis of questions asked by family doctors regarding patient care". BMJ 319: 358–61. PMID 10435959. [e] PubMed Central
- ↑ Haynes RB (2006). "Of studies, syntheses, synopses, summaries, and systems: the "5S" evolution of information services for evidence-based health care decisions". ACP J. Club 145 (3): A8. PMID 17080967. [e]
- ↑ Patel MR, Schardt CM, Sanders LL, Keitz SA (2006). "Randomized trial for answers to clinical questions: evaluating a pre-appraised versus a MEDLINE search protocol". Journal of the Medical Library Association : JMLA 94 (4): 382–7. PMID 17082828. [e]
- ↑ McCord G et al (March 2007). "Answering questions at the point of care: do residents practice EBM or manage information sources?". Acad Med 82: 298–303. DOI:10.1097/ACM.0b013e3180307fed. PMID 17327723. Research Blogging.
- ↑ Papadakis MA et al. (2005). "Disciplinary action by medical boards and prior behavior in medical school". N Engl J Med 353: 2673–82. DOI:10.1056/NEJMsa052596. PMID 16371633. Research Blogging.