Measuring the Impact of Guideline Concordance
The More Things Change, the More They Stay the Same
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See Article by Barnett et al
In October 1998, a group working with the RAND (Research and Development) corporation began making 13 000 telephone calls to random individuals in 12 American cities to ask people about their health care.1 The investigators suspected that a proportion of Americans might not be receiving proven, evidence-based measures. Among 6712 adults who were willing to discuss this and had medical records available for corroboration, it was discovered that 54.9% received guideline-recommended care. This estimate was almost identical for all types of care—preventive, management of acute or chronic conditions, screening for disease, and follow-up. This labor-intensive exercise touched on all aspects of healthcare delivery but found evidence-based care lacking in areas as fundamental as aspirin after myocardial infarction in only 61% of eligible recipients. Recommended care was being followed by 65% of patients with hypertension and 68% with coronary artery disease (CAD). The authors dutifully acknowledged the potential bias inherent in this type of study but made the convincing argument that evidence-based care delivery to approximately half of all patients is a problem. Although the concepts certainly preexisted this study, this was arguably a pivotal point in the case for 2 critical components of evidence-based medicine—knowledge translation and valid methods of assessing evidence concordant care.
The completion of a clinical trial that demonstrates an important health benefit is a celebrated event and can feel like a grand conclusion to the investigators. Yet it can be viewed as only the beginning because the results need to reach medical practitioners in large and small centers, healthcare policy makers, and patients who stand to benefit. The Canadian Institutes of Health Research defines knowledge translation as a dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health, provide more effective health …