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Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap.

Publication ,  Journal Article
Chew, SY; Koh, MS; Loo, CM; Thumboo, J; Shantakumar, S; Matchar, DB
Published in: Ann Acad Med Singap
December 2018

Clinical practice guidelines (CPGs) have become ubiquitous in every field of medicine today but there has been limited success in implementation and improvement in health outcomes. Guidelines are largely based on the results of traditional randomised controlled trials (RCTs) which adopt a highly selective process to maximise the intervention's chance of demonstrating efficacy thus having high internal validity but lacking external validity. Therefore, guidelines based on these RCTs often suffer from a gap between trial efficacy and real world effectiveness and is one of the common reasons contributing to poor guideline adherence by physicians. "Real World Evidence" (RWE) can complement RCTs in CPG development. RWE-in the form of data from integrated electronic health records-represents the vast and varied collective experience of frontline doctors and patients. RWE has the potential to fill the gap in current guidelines by balancing information about whether a test or treatment works (efficacy) with data on how it works in real world practice (effectiveness). RWE can also advance the agenda of precision medicine in everyday practice by engaging frontline stakeholders in pragmatic biomarker studies. This will enable guideline developers to more precisely determine not only whether a clinical test or treatment is recommended, but for whom and when. Singapore is well positioned to ride the big data and RWE wave as we have the advantages of high digital interconnectivity, an integrated National Electronic Health Record (NEHR), and governmental support in the form of the Smart Nation initiative.

Duke Scholars

Published In

Ann Acad Med Singap

EISSN

2972-4066

Publication Date

December 2018

Volume

47

Issue

12

Start / End Page

523 / 527

Location

Singapore

Related Subject Headings

  • Singapore
  • Precision Medicine
  • Pragmatic Clinical Trials as Topic
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Humans
  • Guideline Adherence
  • General & Internal Medicine
  • Evidence-Based Medicine
  • Electronic Health Records
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Chew, S. Y., Koh, M. S., Loo, C. M., Thumboo, J., Shantakumar, S., & Matchar, D. B. (2018). Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap. Ann Acad Med Singap, 47(12), 523–527.
Chew, Si Yuan, Mariko S. Koh, Chian Min Loo, Julian Thumboo, Sumitra Shantakumar, and David B. Matchar. “Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap.Ann Acad Med Singap 47, no. 12 (December 2018): 523–27.
Chew SY, Koh MS, Loo CM, Thumboo J, Shantakumar S, Matchar DB. Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap. Ann Acad Med Singap. 2018 Dec;47(12):523–7.
Chew, Si Yuan, et al. “Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap.Ann Acad Med Singap, vol. 47, no. 12, Dec. 2018, pp. 523–27.
Chew SY, Koh MS, Loo CM, Thumboo J, Shantakumar S, Matchar DB. Making Clinical Practice Guidelines Pragmatic: How Big Data and Real World Evidence Can Close the Gap. Ann Acad Med Singap. 2018 Dec;47(12):523–527.

Published In

Ann Acad Med Singap

EISSN

2972-4066

Publication Date

December 2018

Volume

47

Issue

12

Start / End Page

523 / 527

Location

Singapore

Related Subject Headings

  • Singapore
  • Precision Medicine
  • Pragmatic Clinical Trials as Topic
  • Practice Patterns, Physicians'
  • Practice Guidelines as Topic
  • Humans
  • Guideline Adherence
  • General & Internal Medicine
  • Evidence-Based Medicine
  • Electronic Health Records