Abstract #300088

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JSM 2003 Abstract #300088
Activity Number: 7
Type: Invited
Date/Time: Sunday, August 3, 2003 : 2:00 PM to 3:50 PM
Sponsor: WNAR
Abstract - #300088
Title: Evidence Beyond EBM: Cultivating Clinical Experience through Evidence Farming
Author(s): Richard L. Kravitz*+ and Naihua Duan
Companies: University of California, Davis and University of California, Los Angeles
Address: Ctr. for Health Services Reserach in Primary Care, Sacramento, CA, 95817,
Keywords: electronic medical records ; Bayes methods ; randomized controlled trials ; observational studies ; evidence based medicine
Abstract:

Evidence-based medicine (EBM) is an important paradigm for clinical practice, but the interpretation of evidence under EBM has been narrow in many respects. The evidence in EBM is derived primarily from randomized controlled trials (RCTs), which are conducted under dramatically different conditions from everyday clinical care. The production and dissemination of evidence under EBM follows a top-down approach, with experts conducting trials, synthesizing the literature, and developing guidelines for practitioners to adopt. Ironically, EBM has largely ignored the evidence that is available in practitioners' own data (e.g., patient records). We propose "evidence farming" as a "bottom-up" approach to incorporate practice data systematically as a source of evidence. With the gradual adoption of electronic medical record systems and decision support systems, it is becoming feasible for practitioners to retrieve local endogenous evidence (or "home grown evidence") from their own data. Compared to externally (exogenously) generated evidence emphasized in EBM, such local endogenous evidence is potentially more relevant and more palatable to practitioners.

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