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Evidence-Based Medicine and Comparative Effectiveness Research

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Comparative Effectiveness Research in Health Services

Part of the book series: Health Services Research ((HEALTHSR))

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Abstract

This chapter first covers a historical overview of the development of evidence-based medicine. It then describes the first and second principles of EBM: (1) there exists a hierarchy of evidence and not all evidence is the same; users of comparative effectiveness research (CER) need to have different levels of confidence in the evidence based on its risk of bias, and (2) evidence alone is not sufficient for clinical practice; other factors such as patient values and preferences and clinical context need to be included in the process of decision-making. The chapter transitions to describe how the framework of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) allows CER evidence users to practically apply the two principles of EBM. GRADE gives a quality rating of CER evidence and transforms this evidence to a clinical recommendation that incorporates nonevidence factors. Diagnostic studies, a unique type of CER, are also subject to the same EBM framework. Finally, a case study is described to demonstrate the use of EBM and CER principles to translate a clinical prediction rule into practice using shared decision-making. This case study exhibits how EBM and CER can be utilized to provide evidence-based and individualized patient care.

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Author information

Authors and Affiliations

  1. Knowledge and Evaluation Research Unit, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    M. Hassan Murad & Victor M. Montori

  2. Department of Emergency, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Erik P. Hess

Authors
  1. M. Hassan Murad
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  2. Erik P. Hess
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  3. Victor M. Montori
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Corresponding author

Correspondence to M. Hassan Murad .

Editor information

Editors and Affiliations

  1. Department of Community Health and Epide, Dalhousie University Centre for Clinical Research, Halifax, Nova Scotia, Canada

    Adrian Levy

  2. The University of British Columbia School of Population and Public Health, Vancouver, British Columbia, Canada

    Boris Sobolev

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Murad, M.H., Hess, E.P., Montori, V.M. (2015). Evidence-Based Medicine and Comparative Effectiveness Research. In: Levy, A., Sobolev, B. (eds) Comparative Effectiveness Research in Health Services. Health Services Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7586-7_20-1

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  • DOI: https://doi.org/10.1007/978-1-4899-7586-7_20-1

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  • Publisher Name: Springer, Boston, MA

  • Online ISBN: 978-1-4899-7586-7

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