American Journal of Bioethics.

Clinical Ethics Consultation: A Need for Evidence

Many aspects of health care rest on an insufficient bedrock of evidence. Much of clinical practice involves choices between treatment options, but an absence of evidence to make a decision. This often results in variation in practice by training, geography, and by many other exogenous factors (including the influence of drug detailers, direct to consumer advertising, and small gifts). A great deal of funding and effort is underway to improve this situation, through increasing patient centered outcomes research and pragmatic trials aimed at evaluating the comparative effectiveness of different practices. Between the Patient Centered Outcomes Research Institute (PCORI) and efforts at NIH (particularly though the National Center for Advancing Translational Science and the NIH Collaboratory) funding of research to improve the evidentiary basis for clinical choices. In addition, the “quality revolution” and the development of the large data available from electronic healthcare records has created “the Learning Healthcare System” as a way of improving clinical performance in a systematic, evidence-based process. […]

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Volume 15, Issue 1
January 2015