Evidence-Based Medicine Comes to Otolaryngology

Through its leadership, the AAO-HNSF has taken it upon itself to grow a cadre of physicians and other stakeholders willing to write guidelines, to fund them, and to accept how they define state-of-the-art medicine. Aware of the consequences of not developing EBM guidelines, the AAO-HNSF is footing the bill, which will probably run between $100,000 and $200,000 for a multidisciplinary team of experts to produce guidelines. In June 2006 the AAO-HNSF took a big step toward creating these measures by sponsoring the Translating Research Into Cross-Specialty Measures Conference (TRICSM; visit www.entnet.org , search TRICSM for more information). A stellar planning committee, chaired by Dr. Nielsen, laid the groundwork for EBM development through sessions on how to link research to performance measures, stakeholder demands (professionals, purchasers, board certification), aggregating demands, quality-based purchasing, and quality-based certification and licensing.

By setting clinical standards for the professional and payer communities by which to evaluate specialist performance, the guideline developers are operationalizing excellent clinical care. For practitioners, EBM’s action statements are based on systematic literature review. Through collaborations such as TRICSM, those charged with guideline development build consensus on how to describe desired physician behaviors, and lay out recommendations, strategies, and information for getting there. EBM guidelines help physicians and other practitioners make informed decisions while leaving professional autonomy intact (see sidebar).

The consequences of not bringing order to the hundreds of measures that currently exist related to otolaryngology practice, in which wide variations exist in evidence base, relevance, and validation, are clear. In the absence of strong clinical leadership administrative, cost, capacity, and fiscal measures will be imposed on physicians. Taking control of the process short-circuits that possibility.

Dr. Nielsen emphasized that producing evidence-based guidelines will benefit Academy members and help otolaryngology catch up with other subspecialties that are further along in EBM development. Our goals are to aggregate the demand for performance measures and guidelines, and to unify our response as a specialty so that we avoid duplicative effort, wasted resources, and internal competition, he added.

Real Progress

Richard Rosenfeld, MD, MPH, Professor of Otolaryngology at the Long Island College Hospital in Brooklyn, N.Y., is ensuring that the AAO-HNSF’s mandate for a comprehensive guideline development program forges ahead. He explained: In the past a bunch of ENT experts got together in a cozy place, backed by pharmaceutical funding, to produce consensus guidelines. Those guidelines were better than nothing, but they were biased and flawed. We realized that we had to do much better.