December 5, 2003

VUMC to lead evidence-based medicine effort

Featured Image

Contemporary Christian artist Steven Curtis Chapman gives Dakota Poole a lesson on his guitar during a holiday caroling visit by Music Row artists Tuesday. Organized by the board of directors of the T.J. Martell Foundation, more than a dozen musicians, songwriters and singers visited patients in the Vanderbilt Children's Hospital and the Vanderbilt-Ingram Cancer Center to kick off the holidays.

VUMC to lead evidence-based medicine effort

With national reports decrying variability of medical practice as a cause of poor outcomes and wasted resources, greater day-to-day reliance on medical evidence is emerging as a keystone of health care reform.

The nation’s health system is highly fragmented, and the adoption of evidence-based practice has proven elusive. In 2001, the authors of a high-profile report from the Institute of Medicine depicted a quality chasm in American health care between the recommendations of medical science and the realities of medical practice. Strategies to support concerted use of evidence were among the chief recommendations of the report.

Vice Chancellor Harry R. Jacobson and School of Medicine Dean Steven G. Gabbe recently conceived a new VUMC center to help stimulate widespread acceptance of evidence-based medicine as the foundation for health system transformation.

“Variability of care leaves the health system dangerously compromised and in need of innovative new approaches to ensure best practice,” Jacobson said. “Wide adoption of evidence-based medicine, where the best evidence exists, is a challenging but absolutely essential goal. It will be very important for Vanderbilt Medical Center faculty, house staff and students to set the example for optimal use of best evidence in the management of patients. This new center, coupled with the powerful information technology infrastructure we have, will focus heavily on assisting us to be that example.”

“This initiative represents another opportunity for Vanderbilt to share its strengths and occupy the forefront of the national conversation about health care,” Gabbe said. “As the new center forges relationships and enters into projects with various organizations across the health system, it will also tap the talent and expertise residing here at VUMC. We want to engage our own organization to the utmost in evidence-based medicine.”

The founding director of the Vanderbilt Center for Evidence-based Medicine is economist and health care industry expert Paul H. Keckley, Ph.D. He said the center will evaluate how evidence-based medicine is most effectively applied, pursuing short-term projects in collaboration with hospitals, health plans, employers and others, as well as long-term grant-funded research. Focusing on Vanderbilt’s own clinical enterprise will ensure that VUMC has credibility as a model.

The center will also work to educate providers at every level, from medical students to hospital board members, aiming to increase general understanding of evidence-based medicine.

“We’ll facilitate adoption of evidence-based medicine by physicians, health systems and payers,” Keckley said. “Wherever possible, we’ll seek to relate external projects to the faculty and programs here at VUMC.”

There are challenges facing the health care system, he said.

“A main challenge is keeping abreast of science as it changes. With 10,000 controlled studies and 400,000 new Medline entries each year, the gap between science and practice is widening.”

Another big challenge is putting incentives in place to reward adherence to evidence-based guidelines by physicians and patients.

He considers evidence-based medicine as casting providers in more of a teaching and coaching role, and engaging patients in self-managed care. As employers move away from funding health benefits, consumers are becoming more directly responsible for funding the health system. In tandem with this trend, Keckley sees a shift toward self-directed care, with consumers more engaged in studying their health care options and weighing benefits and risks. He expects the center to be involved in evaluating and supporting this trend.

Likely initial projects for the center, include: (1) a study of how media cover new medical evidence, (2) development and evaluation of new methods to ensure appropriate diagnosis and coaching of patients with obesity, and (3) an examination of the role that evidence may or may not play in health plan determinations of covered treatments and procedures.

Keckley said he was attracted to the job by the opportunity to balance external projects with internal activity at VUMC, and by Vanderbilt’s exceptional strength in biomedical informatics. He credits the commitment of VUMC leaders.

“Dr. Jacobson and Dr. Gabbe are both very aware and articulate proponents of evidence-based medicine,” he said.

The center is to be self-funded within a year, Keckley expects, and hopes to acquire 10 multi-year corporate partners within two years. Current plans call for the center to have a staff of four initially, with others added based on project needs. The center’s advisory board will include key department chairs and other VUMC leaders.

Faculty interested in collaborating with the center should contact Keckley by e-mail, paul.keckley@ or by phone at 343-3922.