It’s well known that the practice of medicine is not completely evidence-based; in fact, it is estimated that less than 25% of typical medical practice is supported by rigorous evidence, such as controlled clinical trials.  So it is very welcome that, in considering health care reform, the administration wants to enhance the evidence-base for medical care.  Already, there have been some funds from the stimulus package devoted to this, and the Institute of Medicine has a Round Table on this topic.

This is certainly a good thing, but merely producing the evidence isn’t enough.  The findings then have to become part of everyday clinical practice.  It is a reality that many  guidelines and best practices have yet to be fully adopted into clinical practice, or that it takes an unacceptably long time for this to happen.  I suggest, as we move to build up the evidence base for medical practice, that we concurrently develop strategies to link this research directly and meaningfully to the actual delivery of health care.   A guideline is, after all, just a guideline.

- SW