Evidence-Based Medicine Leads to Better Outcomes
Trauma centers that comply with evidence-based medicine for TBI — or any medical condition, for that matter — should be certified and given incentives.
See more of Dr. Ghajar's videos here.
Besides good evidence and besides going in and giving lectures and talking to people, you need some other kind of incentive. And usually in these other kinds it's political. You need to fund things in the hospital. You need to also--I think in the United States we need to get behind evidence-based medicine. We need to start certifying trauma centers based upon their compliance with evidence-based medicine. And I don't mean just traumatic brain injury. There's a lot of very good surgical evidence-based medicine as well for trauma centers. East, for instance, has done a lot of good work in this area. So I think we need the politicians or the certification organizations to get behind evidence-based medicine and not just give it lip service, say, "Yes, we believe in it. And you know what?" "We're going to give a trauma center designation based upon their compliance "with that because it leads to better patient outcome." If they did that, overnight there would be a change. Everyone is very, very keen and very cognizant of certifying organizations. So if a certifying organization said, "We will give you a Level I designation "if you're X percentage compliant" or something like that, that would be great. Also, we should keep track of these things. A lot of times I and other neurosurgeons go into trauma centers to certify them. We look through charts and everything else. Why do we need to do that these days? These days you can have databases and people can enter in data and you can just virtually look to see if somebody is compliant or not. We do that in New York State. So I think besides people being enthusiastic and saying, "Yes, I want to follow evidence-based medicine," we should give them some kind of other incentive, which is trauma center designation, maybe the payers will pay more for good care, maybe your malpractice insurance drops because you do evidence-based medicine. All those things are incentives. And I'm not saying they're all steak; some of them are carrots, like your malpractice insurance drops. So all these things have to be integrated into the implementation of evidence-based medicine. We've got to get these other people involved. I see that when I go to other countries. If I don't see a politician, the Minister of Health, or some other person who is interested at that table, I know it's bound to fail because hospital people alone can't do it. You need to have other people involved that are involved in certification or politics or funding for hospitals or whatever it is because it does take extra effort. It's very easy not to do anything. When you start doing things, it requires a lot of effort and everything else, and people should be-- Well, they're rewarded because they get better patient outcomes, but there should be other rewards in terms of that better patient outcome means reduced costs. The CDC has said following the BTF guidelines leads to $3.8 billion in savings. Well, somebody has got to be-- I'm sure Medicaid would be very interested in that because they're the ones that are the big payer for bad outcomes from traumatic brain injury, if you went to them and said, "If you have people follow the guidelines, "you'll have a much smaller bill at the end of the day." So you need to get more than just the practitioners involved to implement evidence-based guidelines.
Posted on BrainLine February 9, 2012.
Jamshid Ghajar, MD, PhD is chief of Neurosurgery at Jamaica Hospital-Cornell Trauma Center, clinical professor of Neurosurgery at Weill Cornell Medical College and president of the Brain Trauma Foundation.
Produced by Noel Gunther and Justin Rhodes, BrainLine.