ABSTRACT
DAVID W BATES, GILAD J KUPERMAN, SAMUEL WANG, TEJAL GANDHI, ANNE KITTLER, LYNN VOLK, CYNTHIA SPURR, RAMIN KHORASANI, MILENKO TANASIJEVIC, and BLACKFORD MIDDLETON
Delivering outstanding medical care requires providing care that is both high-quality and safe. However, while the knowledge base regarding effective medical therapies continues to improve, the practice of medicine continues to lag behind, and errors are distressingly frequent. [1]
Regarding the gaps between evidence and practice, Lomas et al. [2] evaluated a series of published guidelines and found that it took an average of approximately fi ve years for these guidelines to be adopted into routine practice. Moreover, evidence exists that many guidelines-even those that are broadly accepted-are often not followed. [3 4 5 6 7] For example, approximately 50% of eligible patients do not receive beta blockers after myocardial infarction, [8] and a recent study found that only 33% of patients had low-density lipoprotein (LDL) cholesterol levels at or below the National Cholesterol Education Program recommendations. [5] Of course, in many instances, relevant guidelines are not yet available, but even in these instances, practitioners should consider the evidence if they wish to practice evidence-based medicine, and a core part of practicing evidencebased medicine is considering guidelines when they do exist.
