Effectively Implementing Evidence-Based Medicine

Since its formal introduction into clinical practice more than 20 years ago, evidence-based medicine has become increasingly important. Its impact almost certainly will be even greater in the coming years because payment will be for health outcomes rather than procedures and tests, with decision-making about testing and treatment expected to conform to established guidelines and protocols. As a service to the ophthalmologists it represents and to their patients, the American Academy of Ophthalmology developed and updates guidelines called “Preferred Practice Patterns” (PPPs) on the basis of the best available scientific data as interpreted by panels of knowledgeable health professionals. This process requires the collection, selection, and interpretation of data; their formulation into recommended practice standards; and clear communication of these standards together with their justification. Adherence to PPP guidelines—although not entirely evidence based—should result in improved care outcomes and is increasingly being used as a measure of quality of care. This editorial addresses some of the major challenges and problems that exist in implementing evidence-based medicine into practice.