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J Eval Clin Pract. 2019 Apr 11. doi: 10.1111/jep.13135. [Epub ahead of print]

Evidence-based medicine: A cornerstone for clinical care but not for quality improvement.

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Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada.
Centre for Quality Improvement and Patient Safety and the Department of Medicine, University of Toronto, Toronto, Canada.


Quality improvement (QI) as a clinical improvement science has been criticized for failing to deliver broad patient outcome improvement and for being a top-down regulatory and compliance construct. These critics have argued that the focus of QI should be on increasing adherence to clinical practice guidelines (CPGs) and, as a result, should be consolidated into research structures with the science of evidence-based medicine (EBM) at the helm. We argue that EBM often overestimates the role of knowledge as the root cause of quality problems and focuses almost exclusively on the effectiveness of care while often neglecting the domains of safety, efficiency, patient-centredness, and equity. Successfully addressing quality problems requires a much broader, systems-based view of health-care delivery. Although essential to clinical decision-making and practice, EBM cannot act as the cornerstone of health system improvement.


clinical guidelines; clinical safety; evidence-based medicine; health care; medical research; patient-centred care


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