Evidence based healthcare (EBH) in Orthodontics means that for a given procedure, material or technique, valid studies confirm its effectiveness…in other words, it should work if used in the intended way. Comparative effectiveness studies (CES) determine how a given procedure, material or technique performs relative to others with respect to several factors like: time effectiveness, quality of the result, cost effectiveness and undesirable side effects. There is a consensus that not all of our treatment choices meet both criteria but in a perfect world, they would. That is, the treatments we select should be shown to work reliably and they are better in most respects than the alternatives with fewer side effects.
When we evaluate new methods and materials for use on our patients at Ziman Orthodontics, the primary question we ask is whether or not the new method or material being promoted is proven to be better than what we are currently doing. Manufacturers are continuously updating materials and entrepreneurs compete to bring the next big thing to market. Regulators can pass on the safety of materials that we use but don’t consider either EBH or CES in their approvals. As a consequence, new techniques and materials USUALLY come to market with the barest of supporting data exposing busy providers to sometimes jaded sales people and talking heads with undisclosed financial relationships with the manufacturer. In many cases with the passage of time, research reveals that a material or method previously touted as newest and best was not any better than what was in conventional use at the time. In Orthodontics, we’ve seen it with self ligating braces , early intervention multiple phase therapy and Invisalign tm therapy. Payers, you, me, insurance companies and government should all be interested in materials and methods which meet criteria supporting EBH and CES.
To the extent that the Obamacare legislation fosters this type of analysis, we should be in support of its CES mandate as long as departures are allowed for unusual circumstances that a provider determines are necessary for the welfare of their patient(s). The politics of the day should have no influence on what materials, methods or techniques are selected in treating patients. At Ziman Orthodontics, we are continuously evaluating the latest and greatest products and techniques at the same time searching the literature for validation before using them on our patients.
Hot Topic: Evidence based Orthodontics
With healthcare reform being a major news story, Ziman Orthodontics is pleased to explain how the way we do things is already ahead of the curve.
One of the proposals to change how medical providers are paid is to provide a lump sum to treat a condition ( diabetes for example) over some time frame rather than paying for individual tests and treatments separately one at a time. Proponents maintain that costs will be lowered over time by incentivizing providers to keep their patients healthy. Irrespective of ones position on this proposal, this is what we have been doing at Ziman Orthodontics for 26 years. Fee’s are established at the outset including whatever number of appointments are needed to complete the case along with indefinite future retainer checkups. While other medical/ dental conditions may not lend themselves to this model, we feel orthodontic therapy does.
Another issue relates to the notion that more healthcare is better care. Among some Orthodontists, routine use of multiphased treatments ( Phase I and Phase II ) on children with upper tooth/ jaw prominence (termed Class II malocclusion) is common. Research comparing outcomes however has consistently shown that multiphased treatments do NOT produce better outcomes as compared to single phased therapies. At Ziman Orthodontics we occasionally will utilize such therapy in unique and limited circumstances but it is not the norm nor a standard procedure on our patients. Why is this distinction important? Multiphased treatments are more costly and take longer to complete in total. A recent review of 105 studies by Jung appearing in an industry journal on this very question concluded that early ( Phase I ) treatment is no more effective than one phase of comprehensive therapy in these patient types.
While reforming healthcare is a complex and controversial undertaking, we do our best to adhere to evidence based treatments which offer the best outcomes and value to our patients. Please browse our before/ after images and testimonials elsewhere on our website.
