The impact of evidence on physicians' inpatient treatment decisions.
OBJECTIVE
Previous studies have shown that most medical inpatients receive treatment supported by strong evidence (evidence-based treatment), but they have not assessed whether and how physicians actually use evidence when making their treatment decisions. We investigated whether physicians would change inpatient treatment if presented with the results of a literature search.


METHODS
Before-after study.


METHODS
Large public teaching hospital.


METHODS
Random sample of 146 inpatients cared for by 33 internal medicine attending physicians.


METHODS
After physicians committed to a specific diagnosis and treatment plan, investigators performed standardized literature searches and provided the search results to the attending physicians.


RESULTS
The primary study outcome was the number of patients whose attending physicians would change treatment due to the literature searches. These changes were evaluated by blinded peer review. A secondary outcome was the proportion of patients who received evidence-based treatment before and after the literature searches. Attending physicians changed treatment for 23 (18%) of 130 eligible patients (95% confidence interval, 12% to 24%) as a result of the literature searches. Overall, 86% of patients (112 of 130) received evidence-based treatments before the searches and 87% (113 of 130) after the searches. Changes were not related to whether patients were receiving evidence-based treatment before the search (P =.6). Panels of peer reviewers judged the quality of patient care as improved or maintained for 18 (78%) of the 23 patients with treatment changes.


CONCLUSIONS
Searching the literature could improve the treatment of many medical inpatients, including those already receiving evidence-based treatment.
Lucas
Brian P
BP
Department of Medicine, John H Stroger, Jr. Hospital of Cook County and Rush Medical College, Chicago, IL 60612, USA. brian_lucas@tush.edu
Evans
Arthur T
AT
Reilly
Brendan M
BM
Khodakov
Yuri V
YV
Perumal
Kalyani
K
Rohr
Louis G
LG
Akamah
Joseph A
JA
Alausa
Tunji M
TM
Smith
Christopher A
CA
Smith
Jeremy P
JP
D000328:Adult; D000368:Aged; D002641:Chicago; D003661:Decision Support Techniques; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006746:Hospital Bed Capacity, 500 and over; D006760:Hospitalization; D006766:Hospitals, County; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D012985:Software Design