The role of evidence reports in evidence-based medicine: a mechanism for linking scientific evidence and practice improvement.

STUDY QUESTIONS

In this article two related questions are considered: (1) Why isn't evidence-based medicine (EBM) more consistently implemented? and (2) Using the EBM paradigm, by what mechanism can we link evidence reports to concrete practice improvement activities?

STUDY DESIGN

To motivate a systematic analysis, answers to these questions are framed within the context of a general conceptual model for practice improvement, using as an example the application of this general model to the question of improving anticoagulation.

CONCLUSIONS

The potential role of evidence reports is quite broad and to be most effective, they should (1) be considered as part of a comprehensive strategy for practice improvement and (2) be designed with their customers in mind. A system-based method for using the information from evidence reports involves ultimately suggesting specific practice improvement strategies in which the strategies are defined in terms of (1) a set of functional specifications and (2) a toolbox of implementation options. Such an approach brings to bear the specialized expertise and generalized fund of scientific knowledge used to produce the evidence report, but does so in a way that facilitates local tailoring. That is, while information synthesis should be global, implementation must be local.