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Evidence-Based Medicine Policy Analysis

Evidence-based medicine (EBM), previously translational medicine, can be
defined as improving care based on empirical research and/or hands-on
practice. The EBM’s approach is based on either direct patient care (bottom-
up) or an experiment translated into guidelines (top-down). EBM is used in
either in conjunction or as quality assessment tool(s) for continuous quality
improvement (CQI). The healthcare leader must utilize the evidence to
promote healthcare quality.

 Explain the process of evidence-based analysis.

 Highlight the major players and their roles in EBM policy (i.e.,
government, providers, patients, etc.).
 Explain the EBM “Levels of Evidence” as defined in your course text.
 Review the case “Constraints of the ACA on Evidence-Based
Medicine.”
 Provide a written analysis of the case “Constraints of the ACA on
Evidence-Based Medicine” in Chapter 9 of your textbook. (Utilize
the “Levels of Evidence and Grades of Recommendations” as
defined by the University of Minnesota) Clearinghouse.
 Summarize the policy of EBM in your conclusion.

Your paper

 Must be four to six double-spaced pages in length (not including

title and reference pages) and formatted according to APA style as
outlined in the Writing Center.
 Must include a separate title page with the following:
o Title of paper
o Student’s name
o Course name and number
o Instructor’s name
o Date submitted
 Must use at least four scholarly sources in addition to the course
text.
 Must document all sources in APA style as outlined in the Writing
Center.
 Must include a separate reference page that is formatted according
to APA style as outlined in the Writing Center.

Carefully review the Grading Rubric Links to an external site.for the criteria
that will be used to evaluate your assignment.
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MHA620 Week 3 Assignment

Ayodele Jones

The University of Arizona Global Campus

MHA 620 Health Policy Analyses

Prof. Cardra Burns

December 11, 2022

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Evidence-Based Medicine Policy Analysis

Introduction

When making decisions about healthcare policy, policymakers must have access to the

latest and most accurate scientific evidence. This is where evidence-based medicine (EBM)

comes in. EBM is an approach to medical decision-making that emphasizes using the best

available evidence from clinical research when making decisions about patient care (Elstein,

2004). There has been a growing movement to integrate EBM into healthcare policymaking in

recent years. EBM's many potential benefits in policymaking include improved patient

outcomes, reduced costs, and increased transparency and accountability. However, some

challenges are associated with using EBM in policymaking, such as the need for strong

partnerships between policymakers and clinicians and the challenge of keeping up with the

latest scientific evidence. This paper will explore the concept of EBM and its potential

implications for healthcare policymaking.

The process of evidence-based analysis.

Regarding policy analysis, evidence-based medicine (EBM) is the gold standard. EBM

considers all of the available evidence on a given topic, including research studies, clinical

experience, and patient preferences. This information is then used to develop

recommendations for best practices. The first step in conducting an EBM policy analysis is

identifying the key stakeholders involved in the issue. These stakeholders may include

patients, healthcare providers, insurance companies, and government agencies (Daniell,

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Morton, & Ríos Insua, 2016). Once the stakeholders have been identified, the next step is

gathering all relevant evidence. This evidence can come from various sources, such as

research studies, clinical guidelines, and expert opinion. Once the evidence has been gathered,

it must be critically appraised. This means that the quality of the evidence must be assessed,

and any potential biases must be taken into account. After the evidence has been appraised, it

can be used to develop recommendations for best practices. These recommendations should

be based on what is most likely to produce positive outcomes for patients and other key

stakeholders involved in the issue. It is important to note that EBM is a dynamic process. As

new evidence emerges, policy recommendations may need to be updated. This is why it is

important to keep up with the latest research to ensure those policy recommendations are

based on the best available evidence.

The major players and their roles in EBM policy

There are many different stakeholders involved in EBM policy. The government plays

a role in setting the overall policy direction and providing funding for research and

implementation. Providers are responsible for delivering care based on the best available

evidence and ensuring that patients receive the care that is most likely to help them. Patients

play a role in advocating for themselves and their families and making informed decisions

about their care (Jommi & Minghetti, 2015). Other key players in EBM policy include payers,

who reimburse providers for care; quality improvement organizations, which work to improve

healthcare quality; and professional societies, which develop clinical guidelines and other

tools to help providers deliver evidence-based care.

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Explain the EBM “Levels of Evidence”

The "levels of evidence" defined by the EBM are Level I: Systematic reviews and

meta-analyses of randomized controlled trials. Level II: Randomized controlled trials. Level

III: Non-randomized studies (cohort, case-control, and before-after studies). Level IV: Case

series and expert opinion (Burns, Rohrich, & Chung, 2011). Systematic reviews and meta-

analyses of randomized controlled trials are considered the highest level of evidence because

they provide the best estimate of the effect of an intervention. Randomized controlled trials

are also considered high-quality evidence, but they may be subject to selection bias and other

confounding factors that can impact the results. Non-randomized studies, such as cohort, case-

control, and before-after studies, are lower-quality evidence because they are more likely to

be biased. Case series and expert opinions are generally considered the lowest evidence level.

When considering the level of evidence, it is important to remember that the higher the level

of evidence, the more likely it is that the results are accurate. Systematic reviews and meta-

analyses of randomized controlled trials provide the best estimate of an intervention's effect,

while case series and expert opinions are less reliable (Burns, Rohrich, & Chung, 2011).

Therefore, when making treatment decisions, it is important to base them on the highest level

of evidence available.

Review the case “Constraints of the ACA on Evidence-Based Medicine.”

As the Patient Protection and Affordable Care Act (ACA) is implemented, there will

be many new opportunities for applying for evidence-based medicine (EBM) (Manchikanti et
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al., 2011). However, the ACA also imposes some constraints on EBM that could limit its

effectiveness. First, the ACA requires that all health plans cover essential health benefits

(EHBs), which could lead to more standardized care and less flexibility in tailoring treatment

to individual patients. Second, the ACA's emphasis on preventive care could result in more

resources devoted to low-value activities, such as screening for conditions with little clinical

benefit. Finally, the ACA's focus on reducing costs could lead to decisions based on financial

rather than clinical considerations. Despite these potential constraints, the ACA provides

many opportunities for applying EBM to improve patient care (Bagley & Levy, 2014). For

example, the ACA's requirements for transparency and accountability could incentivize

providers to use only those treatments with the strongest evidence base. In addition,

expanding coverage under the ACA is likely to increase demand for high-quality health care,

which could spur innovation in delivery methods and encourage more research into effective

treatments.

Thus, while the ACA does impose some constraints on EBM, it also creates many

opportunities for using EBM to improve patient care. One potential issue with implementing

EBM under the ACA is that the essential health benefits (EHBs) required by the ACA could

lead to more standardized care and less flexibility in tailoring treatment to individual patients

(Bagley & Levy, 2014). This could limit the effectiveness of EBM, as some treatments may

be more effective for certain patients than others. Another potential issue is that the ACA's

emphasis on preventive care could result in more resources being devoted to low-value

activities, such as screening for conditions with little clinical benefit. This could reduce the

overall effectiveness of EBM, as resources would be diverted away from more clinically-
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effective treatments. Finally, the ACA's focus on reducing costs could lead to decisions based

on financial rather than clinical considerations. This could also limit the effectiveness of

EBM, as cost-effectiveness is only sometimes aligned with clinical effectiveness.

Provide a written analysis of the case "Constraints of the ACA on Evidence-Based

Medicine."

The Affordable Care Act (ACA) places several constraints on evidence-based

medicine (EBM) (Eddy, 2005). First, the ACA requires all health insurance plans to offer

coverage for certain preventive services without cost-sharing. This eliminates one of the

major financial barriers to patients receiving preventive care, but it also means that insurers

are less likely to cover new, unproven preventive services. Second, the ACA imposes new

taxes and fees on health insurers and pharmaceutical companies. These new costs will likely

be passed on to consumers through higher premiums and out-of-pocket costs. Third, the ACA

establishes several new government programs and regulations that will increase the

administrative burden on providers and limit their ability to practice EBM (Eddy, 2005). The

ACA's Medicaid expansion will increase demand for primary care services while reducing

reimbursements. This could lead to provider shortages and decreased healthcare access for

Medicaid patients.

Despite these constraints, providers still have opportunities to practice EBM under the

ACA. For example, the ACA's quality measures incentivize providers to deliver high-quality

care. In addition, some of the ACA's delivery system reforms—such as accountable care

organizations—create incentives for providers to coordinate care and manage populations of

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patients (Manchikanti et al., 2011). Many private insurers are beginning to experiment with

value-based payment models that reward providers for delivering high-quality, cost-effective

care. The ACA’s constraints on EBM are likely to have a negative impact on the quality of

care delivered in the United States. However, providers still have opportunities to improve

care quality within the confines of the ACA.

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Conclusion

In conclusion, the policy of EBM emphasizes the use of scientific evidence to guide

decision-making in healthcare. This evidence can come from various sources, including

clinical trials, observational studies, and expert opinion. EBM aims to provide the best

possible care for patients based on the available evidence. EBM is a process that requires the

active involvement of both healthcare providers and patients. Patients must be willing to ask

questions and seek out information, while healthcare providers must be willing to share

evidence-based recommendations. Ultimately, EBM aims to improve patient outcomes by

making healthcare decisions based on the best available evidence.

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References

Bagley, N., & Levy, H. (2014). Essential health benefits and the Affordable Care Act: Law

and process. Journal of health politics, policy and law, 39(2), 441–465.

Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The levels of evidence and their role in

evidence-based medicine. Plastic and reconstructive surgery, 128(1), 305.

Daniell, K. A., Morton, A., & Ríos Insua, D. (2016). Policy analysis and policy analytics.

Annals of Operations Research, 236(1), 1-13.

Eddy, D. M. (2005). Evidence-based medicine: a unified approach. Health Affairs, 24(1), 9–

17.

Elstein, A. S. (2004). On the origins and development of evidence-based medicine and

medical decision-making. Inflammation Research, 53(2), S184-S189.

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Jommi, C., & Minghetti, P. (2015). Pharmaceutical pricing policies in Italy. In

Pharmaceutical prices in the 21st century (pp. 131-150). Adis, Cham.

Manchikanti, L., Falco, F., Benyamin, R. M., Parr, S. H. A. T., & Hirsch, J. A. (2011). The

impact of comparative effectiveness research on interventional pain management:

evolution from Medicare Modernization Act to Patient Protection and Affordable Care

Act and the Patient-Centered Outcomes Research Institute. Pain Physician, 14(3),

E249.