Editing Evidence-based medicine (section)

=== Current practice ===
By 2000, use of the term ''evidence-based'' had extended to other levels of the health care system. An example is evidence-based health services, which seek to increase the competence of health service decision makers and the practice of evidence-based medicine at the organizational or institutional level.<ref name="gray">{{cite book|author=Gray, J. A. Muir|date=2009|title=Evidence-based Health Care & Public Health|publisher=Churchill Livingstone|isbn=978-0-443-10123-6}}</ref>

The multiple tributaries of evidence-based medicine share an emphasis on the importance of incorporating evidence from formal research in medical policies and decisions. However, because they differ on the extent to which they require good evidence of effectiveness before promoting a guideline or payment policy, a distinction is sometimes made between evidence-based medicine and science-based medicine, which also takes into account factors such as prior plausibility and compatibility with established science (as when medical organizations promote controversial treatments such as [[acupuncture]]).<ref name="AAFP2018">{{cite web |title=AAFP promotes acupuncture |publisher=Science-Based Medicine |date=9 October 2018 |url=https://sciencebasedmedicine.org/aafp-promotes-acupuncture/ |access-date=12 January 2019}}</ref>  Differences also exist regarding the extent to which it is feasible to incorporate individual-level information in decisions. Thus, evidence-based guidelines and policies may not readily "hybridise" with experience-based practices orientated towards ethical clinical judgement, and can lead to contradictions, contest, and unintended crises.<ref name=eddy5 /> The most effective "knowledge leaders" (managers and clinical leaders) use a broad range of management knowledge in their decision making, rather than just formal evidence.<ref name=feinstein2 /> Evidence-based guidelines may provide the basis for [[governmentality]] in health care, and consequently play a central role in the governance of contemporary health care systems.<ref name=sackett />