This volume of Hand Clinics will be devoted to the increasingly important and relevant topic of Evidence Based Medicine or the more inclusive term Evidence-based Practice (EBP). EBP is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and the integration of patients' values and expectations. It is now recognized worldwide as a foundation of quality care and all surgeons and therapists must embrace the concepts and learn the methods. In order to help you become an evidence-based practitioner, this issue will help you develop new skills in find and appraise the best evidence embedded within the volumes of good and bad information available. The issue will focus on how to apply these methods to hand surgery and rehabilitation. The Centers for Medicaid and Medicare Services (CMS), health insurers, and certification boards will provide the impetus for all of us to put into action evidence-based practice. This approach to practice will lead to changes in our behavior. CMS introduced a pay-for-performance (P4P) initiative to promote high quality medical care based on evidence-based medicine by reimbursing top performing hospitals at a higher level than poor performing hospitals. The primary objectives of this program include increasing clinical quality and saving lives. A secondary objective is to improve the cost-effectiveness of health care delivery. Governmental programs like these along with practice guidelines will lead to new expectations on your practice. Whoever controls these initiatives and guidelines, controls medicine and ultimately the flow of money. You don't want to be left behind. This issue will provide you with the basics to get started on your way to practicing evidence-based medicine.
