Permanente medicine in a changing world: challenges and opportunities.

The practice of evidence-based medicine (EBM) is central to the philosophy of the Permanente Medical Groups (PMG), but our beliefs don’t stop the world from changing around us. Physicians practicing EBM within the PMG will face a number of changes in the coming years—both positive and negative. Among the positive changes, the most obvious and perhaps the most significant is the implementation of KP HealthConnect. Kaiser Permanente’s (KP) Care Management Institute recently identified five factors that enabled KP facilities to achieve program-leading performance in diabetes care: • Financial incentives • Action plans (patient-specific and personal) • Automated medical record • Outreach and follow-up • Provider alerts and reminders. Implementation of KP HealthConnect will significantly boost four of the five key success factors for effective diabetes care—all but financial incentives. In addition, a growing number of interregional networks are disseminating EBM throughout KP, including the Guidelines Directors’ group for issues such as colorectal and cervical cancer screening; the Inter-Regional Breast Care Leaders; the Inter-Regional New Technologies Committee; and many others. Another encouraging development is that KP is not alone in seeking to demonstrate the value of multispecialty group practice. The Council of Accountable Physician Practices—an alliance of 28 prominent group practices, including the eight Permanente Medical Groups, the Mayo Clinic, and the Cleveland Clinic— has found that EBM is a key success factor in roughly 80% of all quality improvement projects among its member organizations. Unfortunately, our ability to practice EBM faces a number of challenges. For example, Americans on average are treated with recommended medical care processes only about 50% of the time. Many Permanente physicians probably believe that they outperform the Permanente Medicine in a Changing World: Challenges and Opportunities