064 - L’Appropriatezza e l’EBM
Rivista: Riv Med Lab - JLM, Vol. 5, N. 3-S1, 2004 (SIRSE Srl ed.)
Pagina/e: 64-67
D. Giavarina
Abstract
Since both appropriateness and Evidence Based Medicine
(EBM) depend on the efficacy, they are interconnected.
It is more difficult to define Evidence
Based Laboratory Medicine (EBLM) than to define
EBM regarding the efficacy of care. A first step to
define EBLM is the accuracy. A test accurate in detecting
a disease, that can be effectively treated, is
appropriate.
The accuracy allows to measure efficiency, but efficacy
requires further features (e.g. is it possible to
assess if the result helps diagnostic and/or treatment
decision? are there resources for this diagnostic procedure?...).
There are several tools to determine the accuracy
of a test while it is more difficult to measure the effects
of a test in the outcome, because the outcome
depends also by the treatment prescribed after the
test. EBM is helpful in evaluating diagnostic procedures;
e.g. in estimating the accuracy of a test, in
establishing guidelines and in auditing performances.
Laboratory audit is the review against the benchmark
of current best practice i.e. the review of the
use of a test. Eventually, EBM can play a role in the
identifying the value of a diagnostic service for a
better allocation of resources.