[In-patient treatment decisions].

Area of Science:

• Clinical Medicine
• Evidence-Based Practice
• Health Services Research

Background:

• Assessing the integration of scientific evidence into clinical decision-making is crucial for improving patient care.
• Previous studies have highlighted variability in the application of evidence-based treatments across different healthcare settings.

Purpose of the Study:

• To determine the extent to which treatment decisions for medical inpatients in three Catalan hospitals are supported by published scientific evidence.
• To evaluate the level of evidence (e.g., systematic reviews, randomized controlled trials) underpinning common diagnosis-treatment pairs.

Main Methods:

• A retrospective, cross-sectional study analyzed 980 hospital discharges from three hospitals in Catalunya.
• Diagnosis-treatment pairs (DTPs) were identified, and literature searches were conducted in Cochrane Library and MEDLINE (1966-1998) for systematic reviews or randomized controlled trials (RCTs).
• The level of evidence supporting each DTP was classified, and descriptive analyses were performed.

Main Results:

• Level I evidence (systematic review or RCT) supported treatments for 65.4% of patients.
• Non-experimental or consensus evidence (Level II) was found for 32.6% of cases, and no robust evidence (Level III) for 2%.
• Analysis of unique DTPs showed Level I evidence for 55.7% and Level II for 41%, with variations across diagnostic groups.

Conclusions:

• Approximately two-thirds of patients and half of therapeutic decisions in the studied centers were supported by published systematic reviews or RCTs.
• Evidence levels varied by diagnostic group, suggesting areas for targeted improvement.
• Development of more robust instruments is needed to better assess the clinical application of scientific evidence.