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COVID-19 exacerbated the global need for reliable healthcare information, but the unparalleled urgency and shrinking timeline made things difficult for providers.
A body of evidence, ideally from well-conducted randomized controlled trials and systematic reviews remain the gold standard for establishing an evidentiary basis to guide practice. But the process takes time, and even under the best of circumstances such studies remain vulnerable to bias such that the treatment effect is not always reproducible.
In addition, clinical trials cannot address the myriad of practical questions that arise in day-to-day practice. In the meantime, clinicians must make the best decisions they can for their patients. In that respect, the paradigm has shifted somewhat where it is the best evidence of the moment that matters.
1) Understand the important clinical questions. A community of authors, editors, peer-reviewers and users must work together to define the clinical questions that matter and modify them as new information evolves.
2) Synthesized evidence. Rigorous processes are required to identify and systematically review relevant sources of evidence. These must be synthesized thoughtfully and presented to clinicians in a way that they can be understood quickly and accurately.
3) Recognizable expertise. Clinical experts are essential to translate evidence into recommendations for care. Experts must understand the evidence and what it means for managing patients.
4) Peer review. A team effort is required to ensure that recommendations for care are clear, useful and reflect contemporary thinking. Formal peer-review processes are essential. Feedback from end users should also be incorporated into the editorial process.
5) Transparency. Clinicians need to understand how recommendations for care were derived and the limitations of the evidence so they can formulate their own perspective and assess the applicability of the guidance to the patient in front of them. Grading the strength of recommendations and the quality of evidence using a validated approach can provide a short-hand guide to assist in that process.
6) Rigor and speed. The process must be efficient but cannot sacrifice required stringent and reproducible processes to achieve timeliness.
7) Easy-to-find information. Clinical decision support should come in formats that make the relevant information easily discoverable. Work-flow integration is an important component.