0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Translating Evidence Into Practice:  Are We Neglecting the Neediest?

John A. Spertus, MD, MPH; Mark I. Furman, MD
Arch Intern Med. 2007;167(10):987-988. doi:10.1001/archinte.167.10.987.
Text Size: A A A
Published online

Extract

The rational and efficient application of effective treatment to those who derive the most benefit is an inherent attribute of high-quality health care.1 Yet how are physicians to accomplish this efficient and effective use of treatment within the frenetic pace of patient care? Accomplishing these aims requires adherence to a basic tenet of clinical epidemiology, that for an intervention with a given relative risk reduction, the absolute benefits are greatest in those with the greatest underlying risk.2 For example, if the use of statin therapy in patients with coronary artery disease results in a 30% relative risk reduction in death and the underlying risk of mortality is 20%, then the absolute risk reduction is 6 deaths for each 100 patients treated and the number of patients who need to be treated to save 1 life is 17. Conversely, if the underlying mortality rate is 2%, then the number of patients who need to be treated to save a life is 167. Obviously, much more aggressive treatment is warranted in higher-risk patients, since fewer need to be treated to save a life. Moreover, because all therapies are associated with some degree of risk, the benefits are more likely to outweigh those risks in the patients with the greatest underlying potential to benefit from treatment. Among the most established applications of this clinical logic is the use of bypass surgery, for which patients with the greatest risk for death (eg, those with left main coronary disease or triple-vessel disease with left ventricular dysfunction) are recommended for treatment.35 Consequently, outcomes researchers have developed numerous techniques for risk stratification to assist clinicians in identifying high-risk patients for whom more aggressive use of treatments can be considered.

Topics

translating

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 7

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();