Published 3/1/2011
Kevin G. Shea, MD

EBM, CPGs, and OKO

The AAOS has a wealth of online resources to support EBM

The terms ‘evidence-based practice’ or ‘evidence-based medicine’ (EBM) are being used with increasing frequency when discussing health care. Payers, clinicians, and professional societies are placing emphasis on the use of evidence to guide clinical practice and coverage decisions.

Many clinicians look at the emphasis on evidence as a powerful analytical tool to further define the best treatment options for our patients. The emphasis on EBM leads to the development of clinical practice guidelines (CPGs). These guidelines can be used to support clinical decision-making, to improve the delivery of appropriate health care, and in some cases, to develop quality assessments and performance measures.

The development of CPGs
A CPG is systematically developed to assist the practitioner and patient in making decisions about appropriate health care for one or more specific clinical circumstances. One of the primary goals of a CPG is to develop a transparent, reproducible, and systematic evaluation of the clinical evidence. This will foster greater efficiency within a physician’s practice and reduce the potential for bias in clinical decision-making.

In the past, some guidelines were based on opinion and consensus, with only a secondary emphasis on evidence. These guidelines have many limitations, including bias, reliance on incomplete information, quality of evidence not considered, lack of transparency, and lack of reproducibility.

To address these limitations, many organizations, including the AAOS, have developed rigorous guideline development processes that are based on evidence. Specific rules govern the formulation of the guideline, the identification of evidence, and the evaluation of the strength of the recommendations for specific interventions.

The future of healthcare delivery will include an increased emphasis on evidence-based guidelines, pay for performance, and outcome measures. To remain a leader in the field, the AAOS continues to devote significant resources in this arena. As guidelines are developed and additional stakeholders find value in these products, they will likely be used to support coverage and reimbursement decisions. The AAOS will continue to play an active role in the development of guidelines and focus on evidence-based treatment of orthopaedic conditions.

Expert clinicians within the AAOS must have a major role in the development of these guidelines. AAOS members are in the best position to determine the treatments and interventions that will best serve our patients. These treatments will be evidence-based and will improve the health of our patients and communities in a cost-effective manner. In addition to expert clinicians within the AAOS, specialists in guideline development, statistics, evidence review, quality evaluation, epidemiology, and other fields will be involved with this process, lending increased credibility and providing a valuable resource to AAOS members.

The AAOS has many resources that clinicians can use to learn more about EBM and the CPG process. These include the Council on Research, Quality Assessment, and Technology; several committees (Evidence-Based Practice, Guidelines and Technology Oversight, and Patient Safety, among others), and educational courses providing continuing medical education (CME) credit.

In addition to the AAOS Annual Meeting and subspecialty society meetings, the Orthopaedic Knowledge Online (OKO) Web site has many CME options for the busy clinician (Fig. 1). Consider the following courses, which cover EBM and provide CME:

  • Developing an Evidence-Based Clinical Practice Guideline—designed to help the clinician understand what an evidence-based guideline is, how it is developed, and the steps that the AAOS uses in developing guidelines.
  • Evidence-Based Guidelines: What Do a Study’s Results Mean?—information about identifying meaningful outcome measures within a study and interpreting the study outcomes.
  • Evidence-Based Medicine: Sources of Information and Their Utility—how to use PubMed Clinical Queries to find the highest levels of evidence; strengths and weaknesses of various sources of orthopaedic information.
  • Evidence-Based Orthopaedics: An Introduction—designed to help the clnician understand systematic reviews and interpret levels of evidence and their importance for various types of studies as they apply to orthopaedics
  • In addition, CME is available for all of the AAOS CPGs through the OrthoPortal.

The AAOS Web site is another source of information on evidence-based practice and CPGs. It includes detailed information about the language of EBM, levels of evidence, grades of recommendation, clinical performance measures, how to nominate topics for CPGs, and more.

Links to the resources cited in this article can be found in the online version, available at www.aaosnow.org

Kevin G. Shea, MD, is a member of the Evidence-Based Practice Committee. He can be reached at kshea@intermountainortho.com

Online links:
Developing an Evidence-Based Clinical Practice Guideline

Evidence-Based Guidelines: What Do a Study’s Results Mean?

Evidence-based Medicine: Sources of Information and Their Utility

Evidence-Based Orthopaedics: An Introduction