Evidence-based medicine: the key to guidelines, disease and care management programmes.
BACKGROUND
Evidence-based medicine (EBM) is based on the concept of applying best practice to the diagnosis or treatment of a single patient or clinical question, one patient at one time. Although this is useful as a practitioner seeing patients one at a time, it is limited in its application to populations or to single patients with multiple diseases. I will review how to apply EBM to the structure and implementation of population-based care management programmes.


METHODS
A review of the existing literature on the topic was undertaken in preparation for the First National Disease Management Conference-"Achieving seamless quality care across the continuum"-held between May 25 and 26, 2001. This material has been combined with experience and evidence of the author.


RESULTS
EBM and practice form the basis of the development of evidence-based guidelines that help lay the path for populations of patients with specific conditions. Care and disease management are the programmes that have been developed to implement evidence-based guidelines and best practice and to produce optimal outcomes in populations with chronic conditions, either single or multiple. Examples are presented to further the understanding of the reader.


CONCLUSIONS
To optimally improve the health of a population, chronic collaborative care programmes must be built and implemented that utilise best practice as defined by evidence in the literature.
Friedman
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State University of New York at Buffalo, USA. fried1458@aol.com
D019468:Disease Management; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006801:Humans; D010346:Patient Care Management / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation