Journal of General Internal Medicine

, Volume 19, Issue 5, pp 402–409

The impact of evidence on physicians’ inpatient treatment decisions

  • Brian P. Lucas
  • Arthur T. Evans
  • Brendan M. Reilly
  • Yuri V. Khodakov
  • Kalyani Perumal
  • Louis G. Rohr
  • Joseph A. Akamah
  • Tunji M. Alausa
  • Christopher A. Smith
  • Jeremy P. Smith
Original Articles


OBJECTIVE: Previous studies have shown that most medical inpatients receive treatment supported by strong evidence (evidence-based treatment), but they have not assessed whether and how physicians actually use evidence when making their treatment decisions. We investigated whether physicians would change inpatient treatment if presented with the results of a literature search.

DESIGN: Before-after study.

SETTING: Large public teaching hospital.

PARTICIPANTS: Random sample of 146 inpatients cared for by 33 internal medicine attending physicians.

INTERVENTIONS: After physicians committed to a specific diagnosis and treatment plan, investigators performed standardized literature searches and provided the search results to the attending physicians.

MEASUREMENTS AND MAIN RESULTS: The primary study outcome was the number of patients whose attending physicians would change treatment due to the literature searches. These changes were evaluated by blinded peer review. A secondary outcome was the proportion of patients who received evidence-based treatment before and after the literature searches. Attending physicians changed treatment for 23 (18%) of 130 eligible patients (95% confidence interval, 12% to 24%) as a result of the literature searches. Overall, 86% of patients (112 of 130) received evidence-based treatments before the searches and 87% (113 of 130) after the searches. Changes were not related to whether patients were receiving evidence-based treatment before the search (P=.6). Panels of peer reviewers judged the quality of patient care as improved or maintained for 18 (78%) of the 23 patients with treatment changes.

CONCLUSIONS: Searching the literature could improve the treatment of many medical inpatients, including those already receiving evidence-based treatment.

Key words

evidence-based medicine practice of medicine treatment decisions 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Forsyth G. An inquiry into the drug bill. Med Care. 1963;1:10–16.CrossRefGoogle Scholar
  2. 2.
    Office of Technology Assessment of the Congress of the United States. Assessing the Efficacy and Safety of Medical Technologies. Washington, DC: U.S. Government Printing Office; 1978.Google Scholar
  3. 3.
    Office of Technology Assessment of the Congress of the United States. The Impact of Randomized Clinical Trials on Health Policy and Medical Practice. Washington, DC: U.S. Government Printing Office; 1983.Google Scholar
  4. 4.
    Dubinsky M, Ferguson JH. Analysis of the National Institutes of Health Medicare Coverage Assessment. Int J Technol Assess Health Care. 1990;6:480–8.PubMedCrossRefGoogle Scholar
  5. 5.
    What Proportion of Healthcare Is Evidence Based? Resource Guide. Available at: Accessed July 8, 2003.Google Scholar
  6. 6.
    Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient general medicine is evidence based. Lancet. 1995;346:407–10.PubMedCrossRefGoogle Scholar
  7. 7.
    Michaud G, McGowan JL, van der Jagt R, Wells G, Tugwell P. Are therapeutic decisions supported by evidence from health care research? Arch Intern Med. 1998;158:1665–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Nordin-Johansson A, Asplund K. Randomized controlled trials and consensus as a basis for interventions in internal medicine. J Intern Med. 2000;247:94–104.PubMedCrossRefGoogle Scholar
  9. 9.
    Feinstein AR, Horwitz RI. Problems in the “evidence” of “evidence-based medicine.” Am J Med. 1997;103:529–35.PubMedCrossRefGoogle Scholar
  10. 10.
    van Weel C, Knottnerus JA. Evidence-based interventions and comprehensive treatment. Lancet. 1999;353:916–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Sackett DL, Rosenberg W, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. It’s about integrating individual clinical expertise and the best external evidence. BMJ. 1996;312:71–2.PubMedGoogle Scholar
  12. 12.
    Smith CA, Ganschow PS, Reilly BM, et al. Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability. J Gen Intern Med. 2000;15:710–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Reilly B, Lemon M. Evidence-based morning report: a popular new format in a large teaching hospital. Am J Med. 1997;103:419–26.PubMedCrossRefGoogle Scholar
  14. 14.
    Reilly BM, Hart A, Evans AT. Evidence-based medicine: a passing fancy or the future of primary care? Dis Mon. 1998;44:370–99.PubMedCrossRefGoogle Scholar
  15. 15.
    Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-Based Medicine. How to Practice and Teach EBM. 2nd ed. New York, NY: Churchill Livingstone; 2000.Google Scholar
  16. 16.
    Haynes RB. Of studies, syntheses, synopses, and systems: the “4S” evolution of services for finding the current best evidence. ACP J Club. 2001;134:A11-A13.PubMedGoogle Scholar
  17. 17.
    Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: John Wiley & Sons; 1981:225–33.Google Scholar
  18. 18.
    Fleiss JL. The Design and Analysis of Clinical Experiments. New York, NY: John Wiley & Sons; 1986:14–5.Google Scholar
  19. 19.
    Greenhalgh T. “Is my practice evidence-based?” BMJ. 1996;313:957–8.PubMedGoogle Scholar
  20. 20.
    Guyatt G, Schunemann H, Cook D, Jaeschke R, Pauker S, Bucher H. American College of Chest Physicians. Grades of recommendation for antithrombotic agents. Chest. 2001;119(1 suppl):3S-7S.PubMedCrossRefGoogle Scholar
  21. 21.
    Feinstein AR. An additional basic science for clinical medicine: I. The constraining fundamental paradigms. Ann Intern Med. 1983;99:393–7.PubMedGoogle Scholar
  22. 22.
    Feinstein AR. An additional basic science for clinical medicine: III. The challenges of comparison and measurement. Ann Intern Med. 1983;99:705–12.PubMedGoogle Scholar
  23. 23.
    Sackett DL. … so little time, and … Evidence-Based Medicine. 1997;2:39.Google Scholar
  24. 24.
    Del Mar CB, Silagy CA, Glasziou PP, et al. Feasibility of an evidence-based literature search service for general practitioners. MJA. 2001;175:134–7.PubMedGoogle Scholar
  25. 25.
    Brassey J, Elwyn G, Price C, Kinnersley P. Just in time information for clinicians: a questionnaire evaluation of the ATTRACT project. BMJ. 2001;322:529–30.PubMedCrossRefGoogle Scholar
  26. 26.
    Sackett DL, Straus SE. Finding and applying evidence during clinical rounds: the “evidence cart.” JAMA. 1998;280:1336–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Guyatt GH, Meade MO, Jaeschke RZ, Cook DJ, Haynes RB. Practitioners of evidence based care. BMJ. 2000;320:954–6.PubMedCrossRefGoogle Scholar
  28. 28.
    McColl A, Smith H, White P, Field J. General practitioners’ perceptions of the route to evidence based medicine: a questionnaire survey. BMJ. 1998;316:361–7.PubMedGoogle Scholar
  29. 29.
    Tomlin Z, Humphrey C, Rogers S. General practitioners’ perceptions of effective health care. BMJ. 1999;318:1532–5.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2004

Authors and Affiliations

  • Brian P. Lucas
    • 1
  • Arthur T. Evans
    • 1
  • Brendan M. Reilly
    • 1
  • Yuri V. Khodakov
    • 1
  • Kalyani Perumal
    • 1
  • Louis G. Rohr
    • 1
  • Joseph A. Akamah
    • 1
  • Tunji M. Alausa
    • 1
  • Christopher A. Smith
    • 1
  • Jeremy P. Smith
    • 1
  1. 1.the Department of MedicineJohn H. Stroger, Jr. Hospital of Cook County and Rush Medical CollegeChicago, Ill

Personalised recommendations