Consensus Based Guidelines vs. Evidence Based Medical Guidelines: What’s the Difference?

| | Evidence Based Medicine

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States adopt treatment guidelines to ensure injured employees receive appropriate medical treatment. They adopt either consensus based or evidence based medical guidelines, and the philosophical difference between the two types of guidelines can be substantial.

Consensus Based Guidelines

To develop consensus based guidelines, a state typically appoints experts with specific medical specialties to collaborate and arrive at guidelines appropriate for that state. This workgroup relies on the knowledge and expertise within the group rather than basing the guidelines on medical evidence, such as scientific testing and outcome data.

What are some concerns about consensus based guidelines?

  • Experts appointed to develop the guidelines are often linked to medical or insurance interests that will be financially affected by the guidelines.
  • Appointed medical doctors may not be experts in the specialties for which the guidelines are developed.
  • Health care providers in the workgroup may rely too much on their own treatment experiences in their decision-making.
  • Consensus based guidelines synthesize new information but rely on a specific time period or “snapshot” in time and must undergo frequent reviews to evaluate their accuracy.
  • These guidelines are not typically specific in providing practice guidance. This may delay approval for treatment or cause retrospective medical determinations.

Evidence Based Guidelines

Evidence based medical guidelines (EBM) meet the following criteria:

  • They use scientific and mathematical data to determine both the benefit and harm of a treatment.
  • High-quality research on population samples informs clinical decision-making.
  • They assess the strengths of the evidence related to both risks and benefits of treatments (including the lack of treatment), and ask the question, “Will the treatment do more harm than good?”
  • They are essentially insulated from human bias.

Consensus based medicine relies on the opinions of appointed experts, whereas evidence based medical guidelines is grounded in scientific scrutiny. The differences may not suggest that one form is better than the other, but it is important to understand that human and political factors can influence consensus based medicine. Evidence based medical guidelines, on the other hand, is inherently protected from bias because it is based on objective data.

What are your thoughts on evidence-based guidelines? Join UR Nation and let us know!

Lisa Hannusch

Lisa Hannusch is CEO of UniMed Direct and founder of UR Nation. With experience in virtually every aspect of workers' compensation medical management, she is a nationally recognized authority on effectively managing utilization and medical claim issues. Lisa has direct experience as a healthcare provider, has conducted healthcare fraud investigations leading to prosecution, designed claims and medical software applications, and has worked as an insurance regulator and state agency rule and guideline author. She was an influential leader for requiring evidence-based medical determinations. At UniMed Direct, Lisa has built an industry leading managed care company specializing in ReviewStat – a leader in hosted medical management software, supported with services for UR and a national independent Peer Review Panel.

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