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Evidence Based Medicine > Intro to EBM > Flashcards

Intro to EBM Flashcards

1
Q

What are the goals of EBM?

A

To develop a set of evidence supported practice tools to further lifelong, self-directed learning

Guide informed clinical decisions in caring for patients

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2
Q

What is EBM?

A

“…the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

				--D Sackett, BMJ, 1996

Integrating individual clinical expertise with the best available external clinical evidence from systematic research (Sackett et al., 2000)

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3
Q

How do some “older” clinicians see EBM?

A

“EBM is the increasingly fashionable tendency of a group of young, confident and highly numerate medical academics to belittle the performance of experienced clinicians using a combination of epidemiological jargon and statistical sleight-of-hand”

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4
Q

What does EBM serve to do?

A

Standardize practice while maintaining patient centered care

Promotes life-long learning

Response to practice variability

Provide granularity on complex questions and gray areas

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5
Q

What is the number 1 reason we need EBM?

A

We have A LOT of questions-

2 questions generated per 3 outpatient encounters
5 questions generated per inpatient admission

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6
Q

What is the number 2 reason we need EBM?

A

Traditional sources of information are inadequate

Textbooks are outdated from day 1
Experts often are wrong
Passively listening to CME does not improve skills and knowledge
Medicine is constantly evolving

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7
Q

What percent of questions do primary care physicians try to answer?

A

20-57%

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8
Q

What is the number 3 reason we need EBM?

A

Disparity between increasing diagnostic skills and clinical judgment and decreasing current knowledge and clinical performance.

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9
Q

What did the studies of the 1980s focus on and what did they find?

A

Looked at practice variations

Surgeons were found to be using heterogeneous standards

Showed the need for PROVEN therapies for patients

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10
Q

What things will we confront daily that will utilize EBM?

A

Interpretation of tests

Harms due to exposures

Disease prognostication

Effectiveness of preventative & therapeutic intervention

Costs

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11
Q

What are the two types of EBM questions?

A

Background & Foreground

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12
Q

What are background questions?

A

Ask for general knowledge about a disorder.

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13
Q

What are foreground questions?

A

Ask for specific knowledge about managing patients with a disorder.

i.e, You know how to treat Trichomonas. What about when the patient states she cannot take Flagyl! What do you do?

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14
Q

What are the 3 main skills of EBM?

A

Information Mastery – efficient searching

Critical Appraisal = critical thinking

Application to the patient
-Inclusive of: Best evidence, Clinical experience, Specific clinical situation, and Patient values

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15
Q

How does EBM make us good providers?

A

Competence

Providing highest quality care

Providing individualized care

Respecting the choices and decisions of the patient

Communicating risk and options to patients effectively

Utilization of best practices

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16
Q

How much care in the 1970’s was evidence based?

A

10-20%

17
Q

In 1990’s what percentage of healthcare was evidence based?

A

21%

18
Q

What does effective care “equal”?

A

Evidence based care.

19
Q

What are the two alternates to effective care?

A

Preference-sensitive care & Supply-sensitive care

20
Q

What is preference-sensitive care?

A

Wide variations in provider preference lead to wide variation in health care utilization

‘Surgical signature’

‘Medical signature’

Example: Implementation of shared decision tool reduced prostatectomy 40%

21
Q

What is supply-sensitive care?

A

The more inpatients beds and specialists the more utilization

Increased utilization DOES NOT equal better care

Physicians moving from low to high supply adapt practice to use excess supply

22
Q

What is the three-pronged approach to EBM?

A

Clinical Problem Solving

Medical Informatics

Critical Appraisal of Medical Literature

23
Q

What is clinical problem solving?

A

Lots of Good Questions

A Little Epidemiology

A Little Statistics

24
Q

What are medical informatics?

A

Clinicians with computer medical databases such as PubMed, Cochrine Library, TRIP, DynaMed, National Guidelines Clearinghouse, etc.

25
Q

How do we clinically appraise medical literature?

A

Some statisitics, some epidemiology

Some notion of study design and levels of evidence

Using JAMA based worksheets

26
Q

What does the three pronged approach serve to do?

A

What Evidence-Based Medicine is and is not important?

Importance of “spreading the word”

An attitude switch from an Authority in medicine (“This is the way I do it”) to Evidence indicates this is the best practice

An active, practical approach for “informed consumers”

27
Q

Why do we use evidence-based care?

A

Too many patients

Too many problems

Too many journals

Information overload

Reimbursement

Core Measures

Foster Understanding

Quality Improvement

28
Q

Average time clinician’s spend reading per week

A 
< ½ hour - 3%
1 hour - 46%
1 ½ hours - 23%
2 hours - 20%
> 3 hours - 8%
29
Q

How do you create an EBM prescription?

A

The Pathway to the Truth (the 5 A’s)
Step1: Formulate and Ask a question.
Step 2: Access the evidence
Step 3: Critically Appraise the evidence.
Step 4: Apply the evidence.
Step 5: Assess the use of information in practice.

30
Q

What are the 5 A’s?

A

Ask a question.

Access the evidence.

Critically appraise the evidence.

Apply the evidence.

Assess the use of information in practice.

31
Q

What is POE?

A

Patient-Oriented Evidence

32
Q

What are examples of patient-oriented evidence?

A

Mortality, Morbidity, quality of life

33
Q

What are examples of disease-oriented evidence?

A

Pathophysiology, pharmacology, etiology

34
Q

Which type of evidence is almost always “best”?

A

Patient-Oriented Evidence

35
Q

Do POE and DOE always agree?

A

No

36
Q

What is DOE?

A

Disease-Oriented Evidence

37
Q

What are the 4 kinds of clinical questions?

A

Etiology

Diagnosis

Therapy

Prognosis

38
Q

What does PICO stand for?

A

Patient
Intervention
Comparison Intervention
Outcome

39
Q

What are Hill’s guidelines for determining causation?

A

Strength of the association

Consistency

Specificity – cause should lead to a single effect

Temporality

Biological gradient (i.e dose response)

Biological Plausibility

Coherence with other data

Analogy – similar relationships with other processes

Evidence Based Medicine (2 decks)

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