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

The Growing Emphasis on Evidence

The increased attention to data in clinical practice and health policy settings stems from three factors. First, spiraling health care costs have placed pressure on government and private health plans to scrutinize the effectiveness and appropriateness of service utilization. Second, studies since the 1970s have documented substantial geographic variations in the rate with which procedures and treatments are offered to patients with similar clinical profiles, suggesting that services are either over-or under-utilized. [4]

Studies find that services that patients should be receiving (eg, childhood immunizations, smoking cessation counseling, beta blockers after acute myocardial infarction, warfarin for nonvalvular atrial fibrillation) are not being provided in a large proportion of cases. Conversely, services that are ineffective (eg, routine preoperative testing) are performed with regularity. In other cases, services are misapplied to the wrong patient populations or are delivered incorrectly. Thrombolytic therapy is often not administered quickly enough to be effective. In other cases, frank medical errors cause up to 100,000 deaths each year in the United States. [5]