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TopWhat We Are Talking About Here (In Alphabetical Order):
Consumer-driven Healthcare “enables people to obtain the healthcare they want at a price they are willing to pay” (Herzlinger, 2004). This is clearly an economic perspective (it’s behind the move towards health savings accounts in the U.S.) as championed recently by Regina Herzlinger at Harvard. This term has also been used, however, in a much more expansive context. For instance, “In the consumer-driven model, consumers occupy the primary decision-making role regarding the health care that they receive” (Goodman, 2006). With this conceptual framework, the patient is at the center of all healthcare decision-making, not just the economic aspects thereof.
Evidence-based Medicine (EBM) is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al., 2006, p. 71). This early definition -(and the one still used on Oxford’s Centre for Evidence-based Medicine’s website (www.cebm.net) is provider-focused. Subsequently, in 2000, the definition was modified to include patient values and preferences as implicit in every clinical decision (Guyatt et al., 2000). One might quibble about whether patient values and preferences should in fact be explicit, not implicit, but suffice to say that it is now widely recognized that EBM is a three-legged stool, comprised of the triad of evidence +provider expertise + patient preferences. In this EBM framework, provider expertise is needed to bridge the inferential gap between population-based evidence and the individual patient. And each patient's values and preferences should narrow that inferential gap further. But since the introduction of EBM nearly two decades ago, the primary focus of EBM proponents has been on evidence, seemingly at the expense of patient preferences and provider expertise. Perhaps this is why the promise of EBM to foster the most efficient and high quality healthcare has not yet been realized.