Position Statement: Evidence-Based Medicine
Evidence-Based Medicine (EBM) (or more appropriately termed Evidence-Based Practice) is an approach to the practice of healthcare comprised of the synthesis of the best available evidence from the biomedical literature, the clinical expertise of the provider, and the preferences of the patient. Overall, the practice of EBM can lead to improved patient care outcomes and increased quality of care. While certain guidelines and recommendations are steeped in strong, sound evidence, it is important to note that the best available biomedical evidence is often incomplete and/or is developed at the epidemiologic level, and should, therefore, serve as a guide for the provider that must be interpreted and applied with professional judgment to the care of individual patient.
EBM also includes a rigorous framework for the assessment and classification of biomedical evidence whereby the quality of the evidence is graded based on the study design and the potential for error and bias that could lead to false or misleading results.
The AAO-HNS supports and endorses EBM when it includes these essential components:
• Clinical expertise
• Best available external evidence
• Individual patient preference
However, the AAO-HNS also cautions that evidence-based recommendations can change over time as data accumulates and our knowledge grows. Moreover, a current absence of data does not equate to an absence of effectiveness. As such, research evidence is often not the sole determinant of clinical decisions. Evidence must be interpreted in the context of each individual patient, and clinical decisions are usually made using the best available evidence in conjunction with clinical expertise and judgment. Therefore, the AAO-HNS feels that third-party payers should recognize that EBM levels of evidence range from 1 to 4, or are placed into graded categories based on the strength of the available evidence (A-D) and that the available evidence relating to a patient’s condition should be applied in the context of a particular patient’s situation. The lack of adequate evidence should never be used as the sole consideration for the determination of medical necessity or payment.
Important Disclaimer Notice (Updated 7/31/14)
Position statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official position statements and are added to the existing position statement library. In no sense do they represent a standard of care. The applicability of position statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical position statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this position statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position statements are not intended to and should not be treated as legal, medical, or business advice.