QUALITY/INTERNATIONAL: A great check list and more about EBM

Humphrey Taylor from Harris mentioned to me earlier this year that one thing Americans don’t realize is how much other health care systems are changing—while ours seems stuck in 1987. One case in major point is the UK where serious changes in terms of more money being spent on health care (a designed increase of nearly 2% of GDP), a reorganization of primary care called Primary Care Trusts, a major investment in IT for healthcare, and a significant change towards paying primary care docs for outcomes have all been going on in the last few years. In fact probably the most Americans realize about this is the scene in Sicko where the British GP discusses his salary (much higher than PCPs get in the US), shows off his fancy car and nice house, and explains that he gets paid more for keeping his patients healthy. All true and all recent phenomena.

Behind this is a move towards the UK valuing evidence based-medicine in reality rather than just rhetoric. What we know about EBM is that it’s really hard to figure out.

So when I got some email from a company in London called Bazian asking for some of my slides, I asked them what they were up to. (OK, they flattered me by saying that a talk I gave last year was mandatory viewing for an introduction to US health care for their team).

Bazian has some pretty neat stuff. One is an introduction to the concept of EBM (or as the Brits call it EBHC). You’ll also find out that they’re named after the guy who gave us Bayesian probability, and yes I never quite figured out what that was in my stats class either! Take a look at the presentation (the guy in the first slide is the non-exported British sci-fi hero Dr Who—which occupies a place in British culture that’s the equivalent of Star Trek crossed with Dick Clark!). Once you’re done with that, they have an excellent and very short slide set of check lists on how to use EBM in health care purchasing. (Of course you could use that check list for cancer drugs….if you can afford the bodyguards!)

So who are these guys? I asked my correspondent Tom Donald:

Snapshot about us: Bazian was founded in 1999 by two of the doctors who designed BMJ’s Clinical Evidence – a landmark publication in the evidence-based world. Company has been the “Intel Inside” key UK evidence-based products including Clinical Evidence and the Map of Medicine. We’ve pioneered the industrialisation of evidence such that we can do evidence-based analyses in 1-3 months that take other groups 12-24 months, at a fraction of the cost. We also provide rapid and responsive evidence-based technology assessments to NHS PCTs and cleared NICEs backlog of tech assessments in 2002. So traditionally we’ve sold customised EB content to publishers and the NHS, but we’re “Grove-ing” (see Eating the Big Fish by Adam Morgan) from supplier to developing our own products, from NHS-dependent to new markets including the US.

In other words, like Deming’s quality initiatives, this may be another American concept (EBM) getting a better hearing abroad, and then returning to bite us in the rear a la Japanese cars in the 1980s. They are also the first to introduce me (at any rate) to the new profession of “evidologist”. And given the stated desire of everyone from plans to employers to politicians in the US to look into evidence based medicine, I suspect they’ll be getting very busy.