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Evidence-Based Medicine Policy Analysis
Tangela Peele
The University of Arizona Global Campus
MHA 620: Health Policy Analyses
Dr. Pamela Brown
May 15, 2023
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Evidence-Based Medicine Policy Analysis
Evidence-based medicine (EBM) has become increasingly important in healthcare settings. EBM utilizes empirical research and firsthand practice to improve patient care (Dizon, 2019). EBM aims to provide patients with the most effective and efficient care possible. In this essay, we will discuss the process of evidence-based analysis, the major players and their roles in
EBM policy, the levels of evidence, and a case study on the constraints of the Affordable Care Act (ACA) on evidence-based medicine. It involves thoroughly analyzing the available research evidence to determine the effectiveness and safety of healthcare interventions. EBM is an indispensable tool in modern healthcare, and healthcare providers, policymakers, and patients widely use it.
EBM Background
The process of evidence-based analysis involves several key steps that must be followed to ensure that the analysis is rigorous and dependable. These steps include formulating a well-
defined clinical question, searching for relevant research evidence, critically appraising the quality of the evidence, synthesizing the results, and applying the findings to clinical practice (Dizon, 2019). The process is iterative, meaning it may need to be repeated as new evidence becomes available or as clinical circumstances change. The significant players in EBM policy include the government, providers, patients, and researchers. The government plays a significant role in EBM policy by funding research and setting regulations that ensure the safety and effectiveness of healthcare practices (Dizon, 2019). Healthcare providers, including physicians, nurses, and other clinical professionals, are responsible for implementing EBM in their clinical practice and staying current with the latest research evidence (Dizon, 2019). Patients also play a crucial role in EBM by participating in research studies and making informed decisions about
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their healthcare are responsible for conducting studies and disseminating their findings to inform EBM policy. Levels of Evidence
The EBM "Levels of Evidence" categorize research studies based on their quality and validity. The EBM "Levels of Evidence," as defined in the course text, are a system for categorizing research evidence based on the strength of its design and the degree of confidence that can be placed in its findings. There are several levels of evidence, ranging from level 1 (high-quality evidence from systematic reviews of randomized controlled trials) to as many as ten levels (low-quality evidence from expert opinion or case reports) (McLaughlin & McLaughlin, 2014). Level 1 evidence is considered the highest quality, consisting of well-
designed randomized controlled trials (RCTs) (Stevens & Kim, 2019). Level 2 evidence includes
non-randomized studies with a control group, while Level 3 evidence consists of non-
randomized studies without a control group (Stevens & Kim, 2019). Level 4 evidence includes case series and case reports, considered the lowest quality evidence, and level 5 evidence from methodical reviews of descriptive and qualitative studies (meta-synthesis) (Stevens & Kim, 2019). The levels of evidence are used to guide clinical decision-making and to determine the strength of recommendations made in clinical guidelines. Constraints of the ACA
The case "Constraints of the ACA on Evidence-Based Medicine" explores the impact of the ACA on EBM policy. The ACA aimed to increase access to healthcare and reduce costs, but it also imposed constraints on EBM practices (Virgin, 2017). The case "Constraints of the ACA on Evidence-Based Medicine," which was presented in Chapter 9 of the textbook, raises several issues regarding the application of evidence-based medicine (EBM) in the United States
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healthcare system (McLaughlin & McLaughlin, 2014). Evidence-based medicine is crucial in providing high-quality healthcare services to patients, and its implementation has been a significant focus for healthcare providers and policymakers (McLaughlin & McLaughlin, 2014). However, the case outlines certain constraints that the Affordable Care Act (ACA) has placed on EBM and the potential implications these constraints may have on healthcare provision.
The ACA, also known as Obamacare, was implemented in 2010 and aimed to expand access to healthcare services to millions of previously uninsured Americans (Virgin, 2017). The law also introduced several provisions to improve the quality of patient healthcare services. One such provision was the establishment of the Center for Medicare and Medicaid Innovation (CMMI), which was tasked with testing innovative payment and service delivery models that would improve healthcare quality and reduce costs (Virgin, 2017). Despite the potential benefits of the CMMI, the case highlights the potential constraints that the center may place on EBM. For
instance, the CMMI may require healthcare providers to adopt specific service delivery models unsupported by the best available evidence (Virgin, 2017). This may result in patients receiving suboptimal care and poorer health outcomes. Additionally, the CMMI may prioritize something other than evaluating innovative service delivery models based on their effectiveness rather than cost-saving measures (Higgins & Greens, 2011). This may limit the potential for implementing evidence-based healthcare delivery models in the United States.
The University of Minnesota's "Levels of Evidence and Grades of Recommendations" provide a valuable framework for evaluating the effectiveness of healthcare interventions. The framework outlines four levels of evidence, with level 1 representing the highest quality of evidence (Institute of Medicine, 2001). The framework also assigns recommendation grades based on the evidence's strength. Grade A represents compelling evidence, while grade D
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represents weak evidence (Institute of Medicine, 2001). The study found that the ACA's constraints on EBM practices significantly reduced access to care and increased costs. Conclusion
In conclusion, evidence-based medicine is essential for delivering high-quality, efficient healthcare. The evidence-based analysis involves a systematic review of scientific literature, and the significant players in EBM policy include the government, providers, patients, and researchers. The EBM "Levels of Evidence" categorize research studies based on their quality and validity. The case study on the constraints of the ACA on evidence-based medicine highlights the importance of utilizing the "Levels of Evidence and Grades of Recommendations" when implementing EBM practices (Virgin, 2017). By understanding the importance of EBM policy, we can improve patient outcomes and promote healthcare quality. Therefore, the policy of EBM is crucial in ensuring that patients receive high-quality healthcare services based on the best available evidence (Higgins & Green, 2011). However, the constraints placed on EBM by the ACA, mainly through the CMMI, may limit the potential for evidence-based healthcare delivery models to be implemented in the United States.
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References
Dizon, R. S. (2019). Evidence-based medicine: principles and practice. American Journal of Obstetrics and Gynecology, 220(3), 228-233.
Higgins, J. P., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions (Vol. 4). John Wiley & Sons.
Institute of Medicine (US) Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press (US).
McLaughlin, C. P., & McLaughlin, C. D. (2014). Health policy analysis: An interdisciplinary approach (2nd ed.). Jones & Bartlett Learning.
Stevens, K. R., & Kim, J. (2019). Evidence‐based medicine. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society, 1-4.
Virgin, R. (2017). The politics of evidence-based policy: The case of the Affordable Care Act. Journal of Health Politics, Policy, and Law, 42(1), 173-182.
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