When Doctors Create Their Own Evidence-Based Medicine

By Jacob Goldstein

Evidence-based medicine sounds straightforward enough, but (like everything else in health care) it’s become pretty contentious. The argument against evidence-based care says, more or less, that no two patients are alike, so doctors must be flexible in their use of evidence and can’t be bound by rigid protocols based on large studies.

But Intermountain Healthcare, a network of hospitals and clinics in Utah and Idaho, has been pushing for more evidence-based care at its facilities for a while now, with some pretty interesting results.

After Intermountain figured out that about a quarter of the elective inductions of labor on its maternity wards were being done before the 39th week of pregnancy (contrary to accepted guidelines), they looked at how the babies fared — and found that those born before 39 weeks were far more likely to wind up in intensive care. When the docs saw those data, the percentage of elective inductions before 39 weeks fell sharply, an Intermountain exec told us a while back.

As it turns out, Intermountain has created a whole system for developing evidence and creating internal protocols — a system explained at some length in a story coming out in this weekend’s New York Times Magazine. One key piece is simply to start measuring how docs are performing a given procedure, to allow the staff to begin to understand variations in care and how they might be correlated with variations in outcomes.

Since developing a protocol for acute respiratory distress syndrome in the late 1980s, Intermountain has developed protocols for some 50 clinical conditions, accounting for more than half of its patients. Doctors, nurses and administrators create the protocols based on internal evidence about what works and what doesn’t. Once a protocol is in place, doctors have the option to override whatever default choices the protocol recommends.

But outcomes seem to improve after the protocols are put in place. A protocol for dealing with one a category of pneumonia cut the death rate associated with the condition by 40% over several years, the article says.

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