Evidence-based medicine versus evidence-based policy

Evidence-based medicine' (EBM) has inspired a great number of clinical practice guidelines in many different fields, all aiming at improving the quality of patient care.Providing high quality care has become increasingly important, but also complex to define.Starting from the Donabedian' triangle of structure, process and outcome, a framework for analysis of quality of care can be created?Structure is defined by characteristics of society and the healthcare system, but also by knowledge, skills and attitudes of healthcare providers and patients within the society.The process refers to all interventions and interactions between patients and providers, and outcome is related to the perception of illness and disease.The role of evidence-based medicine in this framework is restricted to improving the scientific rigour of clinical guidelines and protocols.Nowadays it is becoming clear that in order to contribute to quality of care we need at least three types of evidence: medical, contextual and policy evidence.2Medical evidence refers to 'evidence-based medicine', evidence based on the results of clinical trials and scientific studies.When making decisions for individual patients it is important to take into account patientspecific and health system-related aspects of medical care, the contextual evidence.Likewise, issues such as equity and efficiency, policy evidence, play a role.In