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Challenges in Implementing Evidence-based Medicine

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Annual Update in Intensive Care and Emergency Medicine 2012

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM,volume 2012))

Abstract

Medical knowledge increases rapidly, making it difficult for clinicians to update their practice to allow the incorporation of new advances in care. Arguably the largest deficiency in modern health care is the frequent failure to adhere to evidence-based best practices [1]. These are practices related to the prevention, diagnosis and treatment of disease that have been demonstrated to improve clinically relevant outcomes. Effective interventions fostering best practices are particularly important in critical care services. Progress in most areas of healthcare is leading to a large number of patients living longer and with increasingly complex combinations of diseases and new treatments. Within hospitals, intensive care units (ICUs) are one of the most costly types of care offered, with medical-surgical ICUs accounting for 45 % of admissions to special care units [2].

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References

  1. Chassin MR, Galvin RW (1998) The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA 280: 1000–1005

    Article  PubMed  CAS  Google Scholar 

  2. Leeb K, Jokovic A, Sandhu M, Zinck G (2006) Intensive care in Canada. Healthc Q 9: 32–33

    PubMed  Google Scholar 

  3. Sung NS, Crowley WF, Genel M, et al (2003) Central Challenges Facing the National Clinical Research Enterprise. JAMA 289: 1278–1287

    Article  PubMed  Google Scholar 

  4. Clancy CM (2004) AHRQ’s FY 2005 Budget request: New mission, new vision. Health Serv Res 39: 11–18

    Google Scholar 

  5. Schuster MA, McGlynn EA, Brook RH (2005) How good is the quality of health care in the United States? Milbank Q 83: 843–895

    Article  PubMed  Google Scholar 

  6. Hsu DJ, Stone RA, Obrosky DS, et al (2010) Predictors of timely antibiotic administration for patients hospitalized with community-acquired pneumonia from the cluster-randomized EDCAP trial. Am J Med Sci 339: 307–313

    PubMed  Google Scholar 

  7. Ferrer R, Artigas A, Levy MM et al. (2008) Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain. JAMA 299: 2294–2303

    Article  PubMed  CAS  Google Scholar 

  8. Grimshaw JM, Thomas RE, MacLennan G et al. (2004) Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 8: 3–72

    Google Scholar 

  9. Saint S, Hofer TP, Rose JS, Kaufman SR, McMahon LF Jr (2003) Use of critical pathways to improve efficiency: a cautionary tale. Am J Manag Care 9: 758–765

    PubMed  Google Scholar 

  10. Walsh JM, McDonald KM, Shojania KG, et al (2006) Quality improvement strategies for hypertension management: a systematic review. Med Care 44: 646–657

    Article  PubMed  Google Scholar 

  11. Woolf SH, Johnson RE (2005) The break-even point: when medical advances are less important than improving the fidelity with which they are delivered. Ann Fam Med 3: 545–552

    Article  PubMed  Google Scholar 

  12. Rubenfeld GD, Caldwell E, Peabody E, et al (2005) Incidence and outcomes of acute lung injury. N Engl J Med 353: 1685–1693

    Article  PubMed  CAS  Google Scholar 

  13. The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342: 1301–1308

    Article  Google Scholar 

  14. Treggiari MM, Martin DP, Yanez ND, Caldwell E, Hudson LD, Rubenfeld GD (2007) Effect of intensive care unit organizational model and structure on outcomes in patients with acute lung injury. Am J Respir Crit Care Med 176: 685–690

    Article  PubMed  Google Scholar 

  15. Sinuff T, Cook D, Giacomini M, Heyland D, Dodek P (2007) Facilitating clinician adherence to guidelines in the intensive care unit: A multicenter, qualitative study. Crit Care Med 35: 2083–2089

    Article  PubMed  Google Scholar 

  16. Grol R, Dalhuijsen J, Thomas S, Veld C, Rutten G, Mokkink H (1998) Attributes of clinical guidelines that influence use of guidelines in general practice: observational study. BMJ 317: 858–861

    Article  PubMed  CAS  Google Scholar 

  17. Toma A, Bensimon CM, Dainty KN, Rubenfeld GD, Morrison LJ, Brooks SC (2010) Perceived barriers to therapeutic hypothermia for patients resuscitated from cardiac arrest: a qualitative study of emergency department and critical care workers. Crit Care Med 38: 504–509

    Article  PubMed  Google Scholar 

  18. Cabana MD, Rand CS, Powe NR, et al (1999) Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 282: 1458–1465

    Article  PubMed  CAS  Google Scholar 

  19. Grilli R, Lomas J (1994) Evaluating the message: the relationship between compliance rate and the subject of a practice guideline. Med Care 32: 202–213

    Article  PubMed  CAS  Google Scholar 

  20. Girard TD, Kress JP, Fuchs BD, et al (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371: 126–134

    Article  PubMed  Google Scholar 

  21. van den Berg MJ, de Bakker DH, Spreeuwenberg P, et al (2009) Labour intensity of guidelines may have a greater effect on adherence than GPs’ workload. BMC Fam Pract 10: 74–85

    Article  PubMed  Google Scholar 

  22. Rivers E, Nguyen B, Havstad S, et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345: 1368–1377

    Article  PubMed  CAS  Google Scholar 

  23. Jansen TC, Van Bommel J, Schoonderbeek FJ, et al (2010) Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med 182: 752–761

    Article  PubMed  Google Scholar 

  24. de Ruiter J, Zijlstra JG, Ligtenberg JJ (2011) Does lactate-guided therapy really improve outcome? Am J Respir Crit Care Med 183: 680–680

    Article  PubMed  Google Scholar 

  25. Main DS, Cohen SJ, DiClemente CC (1995) Measuring physician readiness to change cancer screening: preliminary results. Am J Prev Med 11: 54–58

    PubMed  CAS  Google Scholar 

  26. Lazaro P, Murga N, Aguilar D, Hernandez-Presa MA (2010) Therapeutic inertia in the outpatient management of dyslipidemia in patients with ischemic heart disease. The inertia study. Rev Esp Cardiol 63: 1428–1437

    Article  PubMed  Google Scholar 

  27. Meltzer DO (2009) Social science insights into improving workforce effectiveness: examples from the developing field of hospital medicine. J Public Health Manag Pract 15: S18–S23

    PubMed  Google Scholar 

  28. Keating NL, Ayanian JZ, Cleary PD, Marsden PV (2007) Factors affecting influential discussions among physicians: a social network analysis of a primary care practice. J Gen Intern Med 22: 794–798

    Article  PubMed  Google Scholar 

  29. Kucher N, Koo S, Quiroz R, et al (2005) Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 352: 969–977

    Article  PubMed  CAS  Google Scholar 

  30. Resnicow KA, Schorow M, Bloom HG, Massad R (1989) Obstacles to family practitioners’ use of screening tests: determinants of practice? Prev Med 18: 101–112

    Article  PubMed  CAS  Google Scholar 

  31. Schweickert WD, Pohlman MC, Pohlman AS, et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373: 1874–1882

    Article  PubMed  Google Scholar 

  32. Baer M, Frese M (2003) Innovation is not enough: Climates for initiative and psychological safety, process innovations, and firm performance. J Organ Behav 24: 45–68

    Article  Google Scholar 

  33. Kotter JP, Heskett JL (1992) Corporate Culture and Performance. Free Press, New York

    Google Scholar 

  34. Ogbonna E, Harris LC (2000) Leadership style, organizational culture and performance: empirical evidence from UK companies. International Journal of Human Resource Management 11: 766–788

    Article  Google Scholar 

  35. Elenkov DS, Manev IM (2005) Top management leadership and influence on innovation: The role of sociocultural context. J Manage 31: 381–402

    Article  Google Scholar 

  36. Michie S, Abraham C, Eccles MP, Francis JJ, Hardeman W, Johnston M (2011) Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol. Implement Sci 6: 10–17

    Article  PubMed  Google Scholar 

  37. Curtis JR, Cook DJ, Wall RJ, et al (2006) Intensive care unit quality improvement: a “howto” guide for the interdisciplinary team. Crit Care Med 34: 211–218

    Article  PubMed  Google Scholar 

  38. Shojania KG, Ranji SR, McDonald KM, et al (2006) Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA 296: 427–440

    Article  PubMed  CAS  Google Scholar 

  39. Cheng CH, Goldstein MK, Geller E, Levitt RE (2003) The Effects of CPOE on ICU Workflow: An Observational Study. Proc AMIA Symp 150–154

    Google Scholar 

  40. Huang DT, Clermont G, Kong L, et al (2010) Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care 22: 151–161

    Article  PubMed  Google Scholar 

  41. Scott TE, Mannion R, Davies HTO, Marshall MN (2003) Implementing culture change in health care: theory and practice. Int J Qual Health Care 15: 111–118

    Article  PubMed  Google Scholar 

  42. Ramsay CR, Matowe L, Grilli R, Grimshaw JM, Thomas RE (2003) Interrupted time-series designs in health technology assesment: lessons from two systematic reviews of behavior change strategies. Int J Technol Assess Health Care 19: 613–623

    Article  PubMed  Google Scholar 

  43. Shojania KG, Levinson W (2009) Clinicians in quality improvement: A new career pathway in academic medicine. JAMA 301: 766–768

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. A. C. Kajdacsy-Balla Amaral
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  2. G. D. Rubenfeld
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Editor information

Editors and Affiliations

  1. Department of Intensive Care Erasme Hospital, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent (Head) (Head)

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© 2012 Springer-Verlag Berlin Heidelberg

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Kajdacsy-Balla Amaral, A.C., Rubenfeld, G.D. (2012). Challenges in Implementing Evidence-based Medicine. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2012. Annual Update in Intensive Care and Emergency Medicine, vol 2012. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-25716-2_75

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  • DOI: https://doi.org/10.1007/978-3-642-25716-2_75

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-25715-5

  • Online ISBN: 978-3-642-25716-2

  • eBook Packages: MedicineMedicine (R0)

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