PubMed · 10266657
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G R Cratty. 1984. A guide for evaluating word processing system.. https://pubmed.ncbi.nlm.nih.gov/10266657/
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BACKGROUND: In 1992, Evidence-Based Medicine advocates proclaimed a "new paradigm", in which evidence from health care research is the best basis for decisions for individual patients and health systems. Hailed in New York Times Magazine in 2001 as one of the most influential ideas of the year, this approach was initially and provocatively pitted against the traditional teaching of medicine, in which the key elements of knowing for clinical purposes are understanding of basic pathophysiologic mechanisms of disease coupled with clinical experience. This paper reviews the origins, aspirations, philosophical limitations, and practical challenges of evidence-based medicine. DISCUSSION: EBM has long since evolved beyond its initial (mis)conception, that EBM might replace traditional medicine. EBM is now attempting to augment rather than replace individual clinical experience and understanding of basic disease mechanisms. EBM must continue to evolve, however, to address a number of issues including scientific underpinnings, moral stance and consequences, and practical matters of dissemination and application. For example, accelerating the transfer of research findings into clinical practice is often based on incomplete evidence from selected groups of people, who experience a marginal benefit from an expensive technology, raising issues of the generalizability of the findings, and increasing problems with how many and who can afford the new innovations in care. SUMMARY: Advocates of evidence-based medicine want clinicians and consumers to pay attention to the best findings from health care research that are both valid and ready for clinical application. Much remains to be done to reach this goal.
On behalf of the Swedish government, the National Board of Health and Welfare recently issued a recommended set of 60 quality indicators for broad monitoring of the quality of national health care. This initiative is in concordance with similar international initiatives. The Swedish process, however, is unique in the sense that the professions have developed the indicator and more than 40 national quality registers already monitor most of them. Health care professionals in Sweden have a long-standing tradition of measuring and monitoring results including comparing the quality of different health providers by means of the quality registers. However, the transparency by which these measures are presented, the general understanding of how such data should be interpreted and used in practice is as yet not sufficiently developed. Transparency of data combined with knowledgeable interpretation by health professionals will provide patients with sound information about health care quality and the necessary prerequisites for making comparisons between providers. It will also help guiding managers and politicians making decisions. In order to reach this objective, close co-operation between patient organisations, health care managers and the professionals is needed including a common understanding of the needs and perspectives of all parties.
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