Quick Dips

Healthcare: Finding the Evidence

The general public, and particularly medical patients, have until recently taken it for granted that professional healthcare is based firmly on scientific research and consensus on best practice. Not so, according to Professor Michael Brittain of Victoria University's School of Communications and Information Management.

"Throughout the 20th century, most people have assumed that healthcare practice has increasingly been based upon the results of research, and that there is a high degree on consensus amongst healthcare experts about the diagnosis and treatment of diseases and medical conditions. However, until the last decade there has been no systematic quality control and review of outcomes of treatments. Evidence-based healthcare has been patchy," says Brittain.

But now, he says, healthcare professionals are increasingly keen to ensure that their diagnosis and treatments are evidence-based. The general public and patients want to know more about healthcare and treatments; they now question doctors about their work and often search for information themselves.

So where does this information come from and how can you know it's correct? The condition of the medical literature and its cataloguing make it difficult even for medical professionals to access. The vast number of journals presents a costly and time consuming task in indexing and retrieval. Furthermore, the majority of practitioners do not have the time to read and evaluate, over long periods, the results of research.

Brittain has developed a system for sorting out this data, based on the idea of "consensus knowledge" and computer analysis of citations in refereed journals. A citation of a paper is a reference to it in another paper and, generally speaking, the more citations a piece of research receives, the more influential it has been in forming a consensus. The numbers of citations can be found quite easily by computer searches. Citation analysis can be used to highlight key ideas, journals, research centres, publications or authors.

Brittain devised a prototype for a new tool for "mapping" research to help practitioners and the public access consensus data in specialist areas of healthcare, and used this method in a pilot study. He looked at seven medical specialities, including Alzheimer's disease, asthma treatment and the use of aspirin in treating heart disease. For each he searched and sorted data from the Science Citation Index compiled by the Institute of Scientific Information. A first step is the listing of the most cited papers over a certain period -- a simple but highly significant result.

The list shows the reviewer which papers need the most attention, and can identify individuals or research centres influential in a particular field. Citations can be studied over different periods, to follow trends. Brittain has developed a graphing procedure which makes it easy to spot the most influential papers over a given time span.

Brittain acknowledges that this approach requires further development, but says it has a wide range of potential applications, including systematic reviews of key papers in a research field, guidance for health professionals, consensus information for patients and the public, up-to-date reviews for educators and students, and data for healthcare administration, policy and economics.

Although for many decades studies of consensus knowledge were regarded as rather theoretical and without obvious practical applications, the reverse is true nowadays, he says.

There is a big movement towards quality control of information on the Internet -- not only healthcare or consumer information, but in every sector of the economy. Issues of consensus are now regarded as important because consensus is indicative of quality.