Evidence-based medicine is a key component of care that leads and supports Crozer-Keystone Health System’s (CKHS) comprehensive quality initiatives for patients, families, and community. CKHS began formally integrating the principles of EBM into the System’s culture in 2001 by establishing an organizational framework and mechanisms to translate clear science into practice (see figure below by clicking on link).
Crozer-Keystone Health System Evidence-Based Medicine (EBM) Program Structure and Function
The program succeeds not only because of the process- and review-oriented infrastructure that has been built in the last five years, but also because of the institutional culture.
Evidence-based medicine ensures that clinicians are treating patients with particular conditions according to the best scientific evidence. “We have shown that compliance with process measures leads to better outcomes,” says Dale Schumacher, M.D., M.P.H., CKHS clinical informatics officer. “When you measure process indicators rather than outcomes, you don’t have to worry about adjusting for the severity of the patient’s condition. For example, if you’re looking at whether a certain medication was given to a heart failure patient, it doesn’t matter how old they are or what other co-morbidities they have: you either delivered the medication or intervention or you didn’t.”
The Evidence Based Medicine Task Force (EBMTF) receives governance, policy, and strategic guidance from Crozer-Keystone’s Quality of Care Committee (QCC), recommends topics for EBM focus, and establishes expert physician panels for each of the selected topics in consultation with department chairs.
The expert physician panel, which is composed of physician champions, plays a key role in the EBM process, serving as a credible dissemination body that synthesizes, distills, and appraises research and performance information. For each topic, the system’s EBM staff provides panel members with examples of existing evidence-based guidelines from federal and specialty society sources and with key research findings in the literature. The panel is responsible for adapting these external guidelines so they are applicable and responsive to the unique patient care needs of the community served by CKHS.
Once the expert panel refines the guidelines into specific recommendations for care throughout CKHS, EBM staff members determine how to measure current compliance by clinicians. They define the data elements to be gathered and the collection tools that will be used. Then a significant sample of charts per hospital is abstracted. The results are captured and compared with the guidelines to measure the extent to which clinicians are or are not yet providing evidence-based care. Based on these results, the expert panel develops an intervention strategy designed to improve performance (as needed) and disseminates the information to physicians, nurses, and other clinicians. Once the intervention is in place, EBM staff members continuously collect data and feed it back to hospitals and clinicians to help them see their progress in meeting evidence-based guidelines.
Finally, CKHS publicly reports data from our EBM projects through participation in the Hospital Quality Alliance (HQA), a collaboration among various national health agencies, including the Centers for Medicare and Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ), and the American Hospital Association (AHA). Over 4200 hospitals nationwide report through this collaborative. Results can be viewed by hospital at www.hospitalcompare.hhs.gov.