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October 1, 2014

Evidence-Based Practice Is Not Synonymous With Delivery of Uniform Health Care

Author Affiliations
  • 1Division of Evidence-Based Medicine, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa
  • 2H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
  • 3Department of Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada
JAMA. 2014;312(13):1293-1294. doi:10.1001/jama.2014.10713

Current clinical practice is characterized by substantial variation in delivery of health care for the same conditions.1 In turn, clinical variation is considered one of the major drivers of ever-increasing health care costs1 contributing to the estimated 30% of inappropriate or wasteful health care.2 Perhaps as a natural response to this unsatisfactory situation, a widespread and influential school of thought has emerged contending that greater uniformity of clinical practice is desirable.1,3 Advocates maintain that by achieving uniformity in care, practice variation can be decreased, in turn leading to large cost reductions. The suggested mechanism to achieve uniformity in part involves clinician adherence to practice guidelines, which is seen as synonymous with evidence-based practice.3 In this Viewpoint, we explain that this position is based on a misunderstanding of trustworthy guidelines4 and that striving for uniformity of practice as an end is misguided.