How Much Does Practice-Guiding Medical Knowledge Change in One Year?
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Abstract
Background:
Medical knowledge is estimated to double every two to nineteen years, with the most frequently reported estimates of doubling every seven to ten years. Sixteen percent of highly cited research is subsequently contradicted. However, it is unknown how often these changes occur in areas directly affecting clinical decision-making.
We have created and successfully maintained a point-of-care clinical reference that is systematically derived and updated daily from the best available evidence. This provides the opportunity to determine in the current era how frequently the evidence and guidance informing clinical practice changes.
Objective:
To measure the proportion of core practice-driving medical knowledge that changes in one year.
Methods:
Two hundred DynaMed topics were selected for pilot testing of another project to evaluate regionalization of content for a country. These 200 topics were selected in collaboration with physicians from that country to represent common conditions and also uncommon conditions that are important to consider in clinical care, such as emergency management.
For these topics management overview sections which synthesize the most valid and relevant evidence and guidance will be evaluated. For each topic the selected sections will be checked at a current date and compared to a date when they were revised for the aforementioned project. The range of time between assessment points for individual topics is expected to be 9 months to 2 years. For each topic we will analyze the number of lines that changed (added, deleted, or modified). For each change we will classify the change as:
1) Change due to publication of new evidence or guidance (the primary outcome for this analysis)
2) Change due to reviewer and user feedback, including reviewer feedback
3) Change due to internal editorial continuous quality improvement activities
Results:
As of March 6, 2012 the management overviews of 24 topics have been evaluated for a period of 0.84 to 1.78 years. Eighteen topics (75%) were changed based on new evidence and eighteen (75%) were changed based on new guidelines. Twenty-two topics (92%) were changed based on new evidence or new guidelines. Among 1,328 lines in these topic overviews, 349 (26%) were modified and 166 (12.5%) were deleted; 269 new lines (20%) were added. Of the 784 changes, 393 (50%) were due to new evidence or guidelines. The annualized rate of change of overview content due to new evidence or guidelines was 20.8%. Interim results (about 100 topics) will be presented at the conference.
Conclusions:
More than 20% of core information guiding clinical practice is changed within one year based on new evidence or guidelines. When completed, this research will provide the first quantifiable representation of how frequently the core content guiding clinical practice changes. In an era of evidence-based medicine and electronic data management, using textbooks as a marker of standard practice is no longer warranted. Quantifying the frequency of change affecting core clinical practice has significant implications for the frequency of updating evidence-based clinical references, guidelines, medical education, and medical informatics applications.
Medical knowledge is estimated to double every two to nineteen years, with the most frequently reported estimates of doubling every seven to ten years. Sixteen percent of highly cited research is subsequently contradicted. However, it is unknown how often these changes occur in areas directly affecting clinical decision-making.
We have created and successfully maintained a point-of-care clinical reference that is systematically derived and updated daily from the best available evidence. This provides the opportunity to determine in the current era how frequently the evidence and guidance informing clinical practice changes.
Objective:
To measure the proportion of core practice-driving medical knowledge that changes in one year.
Methods:
Two hundred DynaMed topics were selected for pilot testing of another project to evaluate regionalization of content for a country. These 200 topics were selected in collaboration with physicians from that country to represent common conditions and also uncommon conditions that are important to consider in clinical care, such as emergency management.
For these topics management overview sections which synthesize the most valid and relevant evidence and guidance will be evaluated. For each topic the selected sections will be checked at a current date and compared to a date when they were revised for the aforementioned project. The range of time between assessment points for individual topics is expected to be 9 months to 2 years. For each topic we will analyze the number of lines that changed (added, deleted, or modified). For each change we will classify the change as:
1) Change due to publication of new evidence or guidance (the primary outcome for this analysis)
2) Change due to reviewer and user feedback, including reviewer feedback
3) Change due to internal editorial continuous quality improvement activities
Results:
As of March 6, 2012 the management overviews of 24 topics have been evaluated for a period of 0.84 to 1.78 years. Eighteen topics (75%) were changed based on new evidence and eighteen (75%) were changed based on new guidelines. Twenty-two topics (92%) were changed based on new evidence or new guidelines. Among 1,328 lines in these topic overviews, 349 (26%) were modified and 166 (12.5%) were deleted; 269 new lines (20%) were added. Of the 784 changes, 393 (50%) were due to new evidence or guidelines. The annualized rate of change of overview content due to new evidence or guidelines was 20.8%. Interim results (about 100 topics) will be presented at the conference.
Conclusions:
More than 20% of core information guiding clinical practice is changed within one year based on new evidence or guidelines. When completed, this research will provide the first quantifiable representation of how frequently the core content guiding clinical practice changes. In an era of evidence-based medicine and electronic data management, using textbooks as a marker of standard practice is no longer warranted. Quantifying the frequency of change affecting core clinical practice has significant implications for the frequency of updating evidence-based clinical references, guidelines, medical education, and medical informatics applications.
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