Survey Of Evidence-Based Clinical Decision Making In China And Other Countries By Evidence-Based Case Reports

ObjectiveThe situation of evidence-based clinical decision making was investigated in China and other countries,and the course and related factors were analyzed to find the problems in the course of evidence-based clinical decision making.On one hand the related causes were analyzed,and the solutions were raised.On the other hand suggestions were put forward for the writing of evidenced-based case reports. Accordingly,information support was provided for the scientific development of evidence-based clinical decision making.MethodsCBM,China Journals Full-text Database(Medical sciences)of CNKI,and PubMed were used to search clinical evidence-based case reports.Related information was extracted from these reports by the self-designed structured investigation form. Statistic analyses were made by Excel and Chi-square tests were done to compare the situation of evidence-based clinical decision making between China and other countries (It was considered that the difference had statistical significance when P was less than 0.05 in this study).ResultsWe obtained the statistical data of the subject and disease distribution of the cases managed based on evidence-based clinical decision making and the status of the course of evidence-based clinical decision making in China and other countries.1.The situation of the search tools and their used sequence was complicated and diverse during evidence-based clinical decision making in all countries.But the commonest two search tools were Medline/PubMed(China:82.08%;other countries: 81.94%)and Cochrane Library(China:60.38%;other countries:43.06%).Doctors had different abilities when using search tools.30.63%of evidence-based case reports in China and 42.68%of those in other countries described search strategy in detail.9.01 %of evidence-based case reports in China and 36.59%of those in other countries described modification course of search strategy,but it was better in other countries than in China(P＜0.05).2.Doctors in the whole world evaluated the relevance between evidences and diseases,but seldom could evaluate evidences combing all factors of the patients and outside.Other countries were better than China in the fact of evidence evaluation combined with the races of patients(P＜0.05).Doctors in China paid more attention to the evaluation on the scientificalness and validity of evidence than those in other countries(P＜0.05).The methods,index,and grading criteria for the evaluation on the evidence quality were not uniformed in different countries and areas.Doctors in other countries mainly evaluated the quality of evidence based on the scientificalness of research design,while those in China mostly only by grading evidence.3.When applying evidences,all doctors could consider their experience and the condition and request of patients,and the eventual decisions were made by patients themselves or their relatives.4.The evaluation on practice results were more mentioned in Chinese evidence-based case reports(P＜0.05).But the methods of reevaluation were mainly subjective.5.Decision analysis was seldom made during evidence-based clinical decision making in all countries(China:0.90%;other country:3.66%).Decision support systems were seldom used in other countries(3.66%),while they were not used in China.6.Evidence-based clinical decision makings were developed in all departments but more in internal medicine than in surgery and other disciplines.Evidence-based clinical decisions were made mainly for treatment.In the fact of disease severity,the evidence-based practice were mainly done for the diseases which were complicated and difficult and did not harm lives in China(66.67%),while the different types of the diseases that doctors undertook evidence-based clinical decision making were relatively balanced in other countries. ConclusionIn all countries,clinical departments served the patients by evidence-based decision making in different degree.But there are problems in the course of evidence search,evidence appraise,evidence application,and evaluation on practice results,and the development of evidence-based practice was not balanced in different department and disease,which showed that the information diathesis of doctors was low and they were short of evidence-based medicine knowledge.China and other countries had their own strong points in the course of evidence-based clinical decision making and should learn from each other.It is suggested that information education and evidence-based medicine education should be strengthened to improve the doctors' ability of evidence-based clinical decision making.And it is also suggested that the modification of search strategy,what search tools and relevant search strategy used,and evaluation on practice results of each case should be mentioned in evidence-based case reports.