Evidence-Based Medicine and Practice Guidelines - An Overview

Steven H.Woolf, MD, MPH, Department of Family Practice, Medical College of Virginia - Virginia Commonwealth University, Fairfax, Virginia.

Cancer Control. 2000;7(4) 

In This Article


Recent years have witnessed a growing emphasis on evidence. The volume of scientific information has increased dramatically. Thousands of randomized, controlled trials (RCTs) are published each year. Systematic reviews, [1] which summarize the evidence from multiple studies, and meta-analyses, [2] which quantitatively pool data, are increasingly common in general medicine journals and specialty journals. The Cochrane Collaboration, a worldwide effort to conduct systematic reviews, is continuously updating its reports (and other systematic reviews) on an electronic database, the Cochrane Library, which is accessible on CDROMs and the Internet. [3]

Evidence-based medicine (EBM), which seeks to directly link clinical practice and policy decisions to supporting evidence, is receiving increased attention in practice guidelines and public policy. Insurers' decisions about coverage, government decisions about health care financing, and even medicolegal judgments are guided by the results of clinical trials, systematic reviews, and pronouncements in evidence-based practice guidelines. Through its Agency for Healthcare Research and Quality, the federal government has established 12 evidencebased practice centers in institutions in the United States and Canada to perform and publish high-quality evidence reports.

Publications and electronic resources have stepped in to help clinicians and policy makers deal with this explosion of information. Medical journals routinely publish systematic reviews and/or sections that summarize reviews in other journals. Several new journals are devoted entirely to evidence-based medicine, such as ACP Journal Club, Evidence-Based Medicine, Best Evidence, and Evidence-Based Oncology.