November 13, 2012
George Tomlin (Occupational Therapy)
Society's push for "Evidence-Based Medicine"-- and evidence based healthcare practice in general-- has become so strong that certain health insurers are denying payment to practitioners who cannot show published, scientific evidence that the intervention provided is effective. Randomized, controlled trials of treatments have traditionally been placed at the top of single-hierarchy levels of evidence models, and have been portrayed as both necessary and sufficient for demonstrating that a treatment is justifiable.
The single hierarchy of evidence, however, has three serious shortcomings, which are particularly troublesome for professions that use complex means to address complex health problems. The first shortcoming is that single hierarchies devalue qualitative research, which focuses on the lived experience of the recipients of treatment, and outcomes research where control has not been imposed on the data. The second shortcoming is that studies, to the degree that they have strict controls on the participants and on the conditions under which they are studied, are less representative of people living under real-world conditions. The third is that of implementation load, which will be explained in the talk.
For the Colloquium November 13 George presented a new model of evidence hierarchy, the Research Pyramid, and instigated a discussion of pertinent issues.