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Introduction
Evidence-based medicine is the use of systematically reviewed cases to make the best decisions concerning the health of a patient. It involves integrating personal expertise with available best clinical evidence from systematic research in treatment. This practice aims at improving the quality of healthcare and reducing the gap between research or information known and real-life situations. In addition, it reduces variations in interventions. The best evidence-based practice integrates patients values and circumstances, clinical expertise, and research evidence. This paper analyzes evidence-based medicine and the policies governing it.
The Process of Evidence-Based Medicine Analysis
The process of evidence-based analysis involves five major steps. The first step involves formulating of question to be used in finding relevant research. The second step is gathering new practical knowledge needed is identified in this period. The third phase is appraising articles to ascertain their clinical usefulness and validity. The fourth is summarizing the evidence by tabling the results of evidence applications in a clinic. Lastly, the evidence is graded by evaluating clinical performance, and a conclusion statement is developed in the analysis final part.
The Major Players and their Roles in Evidence-Based Medicine Policy
The major key players in the Evidence-Based Medicine (EBM) policy are the government, hospitals, patients, and researchers. The hospitals critical role is to guide patients and provide quality health care based on EBM. Researchers play a significant role in generating new ideas that solve medical issues and challenges. They are also required to improve the health of the population as well as the cost of care. The mandate of the government is to aid in strengthening and planning quality care. It also ensures health care facilities conform to the rules and policies guiding them. Patients are major EBM players because they have to cooperate with medics to achieve maximum benefits from evidence concerning their illness.
The Evidence-Based Levels
The levels of evidence are hierarchical, and they are classified according to their methodological designs and credibility in clinical practice. The first level is systemic review; it involves meta-analysis of relevant evidence from randomized controlled trials. Level two evidence is based on a systemic review of homogeneous cohort studies (Shah et al., 2019). Level three evidence is the results obtained from the systemic review of case-control studies. The fourth level of evidence is derived from case series, case-control studies, and low-quality cohort studies. Level five evidence is based on opinions of health experts, which are not based on mechanistic studies or systemic review results.
The hierarchy of evidence levels is also represented by a pyramid. The bottom part denotes findings from animal research and lab testing. The middle segments are evidence from case-control trials that summarize the treatment of patients without correlation. It is followed by randomized controlled trials, which are experiment designs conducted to reduce bias. Thereafter, the systematic review part of the pyramid follows, which connotes the assessment of high-evidence articles in evidence-based medicine. The highest level is meta-analysis where statistical and quantitative analyses of various randomized controlled trials are critically compared.
Review of the Case Constraints on Evidence-Based Medicine
Evidence-based medicine was emphasized and expanded by the Affordable Care Act (ACA) in the 2009 stimulus rule. It was then established by the Patient-Centered Outcomes Research Institute (PCORI) within the Centers for Medicare & Medicaid Services. However, this legislation restricted the use of the institutes research in the Department of Health and Human Services (Cairney & Oliver, 2017). Federal lawmakers were concerned about controversies that may arise from the research findings in Medicare Advisory Payment Commission. For this reason, they placed constraints on how ACA can utilize evidence-based medicine.
Medicare currently covers the cost of care deemed necessary and reasonable. It does not consider evidence on the charges and effectiveness of treatment relative to others. In addition, Medicare does not compare effectiveness information when determining payment rates for services (Shah et al., 2016). This is because it links the cost of medication to reimbursement. In other countries, comparative effectiveness research is utilized in regulatory stages such as the approval of procedures and new drugs. However, the US restrictions on the use of comparative effectiveness research have been affected. One of the limitations is that secretaries can only use results from research conducted through a transparent and iterative process when approving Medicaid cover (Cairney & Oliver, 2017). In addition, it requires that the evidence gathering procedure should include opinions from the public.
The second restriction is based on the payment for services in Medicaid. Secretaries have been prohibited from approving claims which are solely centered on comparative clinical effectiveness research. The third constraint specifies that evidence from comparative clinical effectiveness research should not be used to determine reimbursement, coverage, or incentive under the title XVIII act (Tolan, 2019). This implies that a life of a terminally ill old person should not be prolonged at the expense of a young person who has no comorbid disorders. Lastly, the law restricts the use of comparative clinical effectiveness research in discouraging patients from choosing a treatment based on their values.
Case Constraint Analysis on Evidenced-Based Medicine
The constraints state that The Secretary may only use evidence and findings from research conducted under section 1181 to determine coverage (McLaughlin & McLaughlin, 2014, p. ). This shows that top-level evidence is used to justify the practice. In this case, evidence from the meta-analysis of systematic studies is appropriate. The constraint stating that The Secretary shall not use evidence or findings from comparative clinical effectiveness research conducted is supported by controlled trials (McLaughlin & McLaughlin, 2014, p. ). Thus, it belongs to the middle level of the evidence pyramid where case-control experiments are utilized.
Summary of the Policy of Evidenced-Based Medicine
The idea of evidence-based medicine is based on reliable and solid gathered evidence that improves health care delivery. Scientific methods are utilized in collecting information to prove facts. Although the outcome of evidence-based medicine is commendable, the government rarely makes decisions based on this. For instance, limitations have been placed on the use of comparative effectiveness research by lawmakers in the United States. It has been observed that the improvement of medical practice is hindered by politicians. This is because they make laws according to their political ideology rather than evidence. Thus, policy decisions concerning health should be made in the presence of some healthcare providers and patients advocates.
Evidence-based medicine is a transparent process that informs decision-making procedures in the health care sector. Clinical decisions are no longer founded on lessons from medical schools and the experiences of patients. This is because the results of rigorous clinical studies have been incorporated in determining treatment plans for each patient. Adopting evidence-based medicine lowers the cost of treatment and improves the quality of care accorded to patients, and, therefore, it should be adopted in clinics.
References
Cairney, P., & Oliver, K. (2017). Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy?. Health Research Policy and Systems, 15(1), 35.
McLaughlin, C. P., & McLaughlin, C. D. (2014). Health policy analysis (2nd ed.). Jones & Bartlett Publishers.
Shah, S. I., Brumberg, H. L., & Bearer, C. F. (2016). Toward development of evidenced-based quality parameters: What gets counted and who gets paid? Pediatric Research, 80(2), 170.
Shah, S., Brumberg, H. L., Kuo, A., Balasubramaniam, V., Wong, S., & Opipari, V. (2019). Academic advocacy and promotion: How to climb a ladder not yet built. The Journal of Pediatrics, 213, 4-7.
Tolan, P. H. (2019). Scaling up evidence-based interventions within the US public health market. Prevention Science, 20(8), 1169-1172.
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