We live in an unprecedented time dominated by a paradox: more money is spent on health care research, development and delivery, and yet health outcomes, quality of care and quality of research is by all measures considered suboptimal. (In fact, 30-50% and 85% of investment health care and research, respectively amount to the waste). The research over last decade have identified two key reasons for such unsatisfactory situation: 1) First, suboptimal health care outcomes can mostly relate to the lack of high quality evidence related to the effects of most interventions. This, in turn, is due, in large part, to severe problems with the clinical research system that mostly generates poor clinical evidence. 2) The second key reason for suboptimal health outcomes relates to inferior decision-making. In fact, it has been demonstrated that “poor decision-making is responsible for the majority of deaths” in the U.S.
Another unprecedented characteristic of our times is that we are now on the verge of accomplishing a century old dream: full integration of research, education/mentoring and clinical practice. The institutions which are not successful in accomplishing this integration and fail to measure the effects of their efforts will be sorely left behind.
A solution to the above identified challenges is 1) to strengthen the reliability of the evidence base by improving science of clinical research, and 2) to improve decision-making, enabling translating research into practice by delivering “the right kind of knowledge at the right time, to the right patient, at the right place”- a goal of personalized medicine. If we are to improve health outcomes, robust evidence must be generated and decision-making must be improved. To accomplish these objectives, we must develop effective methods to measure benefit and harm associated with our health care system, and apply these methods within a rational and ethical framework. An integral aspect of this effort is to educate a new cadre of (clinical) researchers in rigorous (EBM, Patient-Centered) research methods. And, this is what Division of Evidence-based Medicine (EBM) is proposed to do: to apply rigorous EBM methodology to link research, practice and educational efforts in order to improve clinical & education outcomes at Department of Internal Medicine across diverse settings (Morsani Clinics, TGH etc).
Dr. Benjamin Djulbegovic, MD, PhD
Distinguished Professor & Director of Division of Evidence-Based Medicine and Outcomes Research
Dept of Internal Medicine, Morsani College of Medicine