Michael E. Stuart, MD
For over two decades, Dr. Michael E. Stuart has provided skills and tools for medical leaders and health care professionals to assist them in evidence-based medicine (EBM) and the evidence-based clinical improvement process. As president of the Delfini Group he teaches applied evidence- and value-based health care. He makes new methods and practical tools available through Delfini’s evidence-based consultations and highly rated educational seminars which cover topics such as searching and critically appraising the medical literature, clinical guidelines, optimal functioning of P&T and technology assessment committees and other EBM topics. Mike is passionate about his work and is committed to helping achieve improved outcomes that are meaningful, immediately usable, clear and emotionally-rewarding for individuals and groups.

Mike is a contributing author to the textbook, Evidence-Based Clinical Practice: Concepts and Approaches and, along with Sheri Strite, to the textbook, Evidence-based Pharmacotherapy. Topics on which Mike has authored or co-authored articles and book chapters include clinical guidelines and the evidence-based clinical improvement process, the use of balance sheets (projecting economic and health outcomes) in planning evidence-based clinical improvements and performance measurement. His work and comments have been published in the New England Journal of Medicine; British Medical Journal, The Physician Executive Journal of Medical Management, Journal of the American Board of Family Practice, HMO Practice, Formulary and others.

Mike has been on the clinical faculty of the University of Washington School of Medicine since 1975 and teaches evidence-based clinical improvements to medical students, residents medical leaders and others in the health care professions. For many years he has presented “Selected Topics in Evidence-based Medicine --Guidelines, Searching and Sources, Critical Appraisal of the Medical Literature--to professionals enrolled in the Medical Practice Quality Measurement and Management certificate course sponsored by the University of Washington School of Medicine and the UW School of Public Health and Community Medicine.

Currently, Mike is an associate editor for DynaMed of Dynamic Medical Information Systems, LLC and a guest editor for the California Pharmacist Journal.

Prior to starting Delfini, Mike directed the Department of Clinical Improvement and Education, along with the Medical Libraries at Group Health Cooperative in Seattle, Washington (1984 - 2002), where he also practiced family medicine (1973 - 1997). In the words of Group Health leaders, Mike is recognized as the "Father of Evidence-based Medicine at Group Health," where he was lauded for exemplifying the very best of Group Health values and practice — "Respect, integrity, scientific discipline, pioneering spirit and stewardship," which he has expanded on in his work in Delfini. In his role at Group Health, Mike was responsible for developing evidence-based guidelines, pathways and clinical recommendations, conducting technology assessments, maintaining the clinical side of GHC’s intranet, leading the patient information initiative and providing continuing medical education. Mike was responsible for developing core evidence-based medicine processes and tools, totaling over 35 evidence-based clinical guidelines, and many more clinical improvement projects. While at Group Health, he also chaired both the Pharmacy & Therapeutics and Medical Technology Assessment Committees. He has also participated actively in the Seattle health care community, e.g., as the evidence-based medicine leader for the King County Health Advisory Task Force (HATF) in 2004. The goal of this "blue ribbon" panel was to recommend innovative and achievable strategies to improve the quality of health while potentially saving hundreds of millions of dollars. A five percent reduction in the growth trend for health care costs in Washington’s largest county was projected to save $128 million per year. The final report contained —
• An approach for developing an initial set of uniform performance measures to be used in the Puget Sound health care market to identify high-quality, cost effective care.
• An education and implementation tool kit for employers, consumers, health plans and clinicians to assist them understand quality and value — and motivate them to use EBM and evidence-based performance measures along with other considerations to make health care and purchasing decisions.

Mike’s work has received accolades from such distinguished colleagues as David Eddy MD, Don Berwick MD, the Health Ministry of New Zealand, and the US Navy’s Bureau of Medicine, as examples. The following is a list of some of the groups and organizations he has assisted through consultations and presentations: The US Congress Office of Technology, Health Care Financing Administration, Washington State Department of Social and Health Services (HRSA, HCA, L&I, and DOH), US Armed Forces, Veterans Health Administration, American College of Physicians, American College of Physician Executives, California Pharmacy Association, Institute for Healthcare Improvement, McKesson (including InterQual), American Academy of Family Practice, Academy of Managed Care Pharmacy, Henry Ford Health System, Kaiser Permanente Care Management Institute, Kaiser Foundation Health Plan, Mercer Human Resources Consulting Company, California Health Plan Pharmacists’ Leadership Group, Southern California Evidence-based Practice Center, Kaiser Permanente - Hawaii, numerous Blue Cross/Blue Shield groups, The Regence Group, Aetna and Group Health Medical Leadership. Mike has participated in policy development and proposals for groups working with State and local governments – such as the King County Health Advisory Task Force, the Rainier Institute and the National Academy for State Health Policy. Together with Sheri Strite and Dr. Bob Crittendon, he has written a white paper entitled "Promoting Better Quality and Decreasing Costs in Health Care," available at http://www.delfini.org/RainierInstitute_Promoting_Quality.pdf.

Other groups Mike has helped understand the basics of evidence-based clinical improvement include the Northwest Pharmacy Benefit and Medical Directors Group, national pharmacy benefits managers, North Pacific Society of Internal Medicine, Institute for Clinical Systems Integration, HMO Research Network, Institute for The Future, Western Region PRO, Washington Office of Insurance Commissioner, Foundation for Medical Excellence, Washington State Labor & Industries, University of California, San Diego, University of Washington School of Medicine and its of School of Public Health and Community Medicine, University of North Carolina at Chapel Hill, Boston University School of Management, Wake Forest University Baptist Medical Center, Quality Health Foundation, Ochsner Medical Center, Virginia Mason Medical Center, Alaska Native Medical Center, Northwest Center for Medical leadership, Sanofi-Synthelabo national education programs on evidence-based medicine, Novartis Pharmaceuticals, Abbott Laboratories and numerous hospitals and health care organizations.

Stuart Publications

• Strite SA, Stuart ME, Urban S. Process steps and suggestions for creating drug monographs and drug class reviews in an evidence-based formulary system. Formulary. April 2008;43:135–145.

• Nguyen K, Equinozio C, Stern C. Esprit Trial [evidence-based medicine review]. California Pharmacist 2008. Vol LV, No 1. Winter 2008: 30-31. (Stuart ME, Strite SA, peer reviewers and guest eds.) Online

• Chiquette E,Posey LM. Evidence-based Pharmacotherapy. American Pharmacists Association. APhA Publications; 1 edition (January 15, 2007). ISBN-10: 1582120684; ISBN-13: 978-1582120683
(Strite SA, Stuart ME, contributing authors. Chapter 7. Applying Evidence-Based Pharmacotherapy to Formulary Decisions)

• Delfini White Paper — Missing Data: Consideration. October 2007, updated February 2008. [WORD] & [PDF]

• Stuart M, Strite SA. 2005 Jan 30. Pitfalls to Performance Measurement. Modern Healthcare. http://www.modernhealthcare.com/article.cms?articleId=38458. Originally published 2006 Jan 23. Accessed 2006 Jan 30. See also related white papers. Delfini White Paper: Evidence-based Performance Measurement: Validity Issues & Avoiding Important Pitfalls — Long Version: Recommended [PDF] and Short Version [PDF]

• Stuart ME, Strite SA. Radical Prostatectomy versus Watchful Waiting. [Letter to the Editor Re: Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical Prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005; 352:1977-84.] N Engl J Med 2005; 353; 12: 1298

• Stuart ME, Strite SA. British Medical Journal Rapid Response: Steroids Not Proven in Bell’s Palsy—The Legacy of Bad Science — response to Piercy J. Primary Care: Bell's Palsy. BMJ 2005; 330:1374 (11 June) Online

• Strite S, Stuart ME. “Closing Quality and Value Gaps. (Part 3)” The Physician Executive, Journal of Medical Management. May/June 2005; 58-61. PDF & Series Online

• Strite S, Stuart ME. “Finding Gaps in Quality and Value. (Part 2)” The Physician Executive, Journal of Medical Management. Mar/Apr 2005; 50-54. PDF

• Stuart ME, Strite SA. Bell’s Palsy. [Letter to the Editor Re: Gilden D. Bell’s Palsy. N Engl J Med 2004;351:1323-31.] N Engl J Med 2005; 352; 4: 416-418.

• Strite S, Stuart ME. “What is an Evidence-Based, Value-Based Health Care System? (Part 1)” The Physician Executive, Journal of Medical Management. Jan/Feb 2005; 50-54. PDF

• Strite SA, Stuart ME. “Response to Proposal for Strength of the Evidence Taxonomy (SORT)” Letter to the Editors. American Family Physician. December 15, 2004; Vol 70. No 12; 2268. Online

• Strite SA, Stuart ME. “Response to ‘Making Evidence-Based Medicine Doable in Everyday Practice: Finding the evidence you need is getting easier than you ever thought possible,” and ‘A Simple Method for Evaluating the Clinical Literature: The "PP-ICONS" approach will help you separate the clinical wheat from the chaff in mere minutes.” Letter to the Editor. Family Practice Management. October 2004; Vol 11. No 9; 14. Online

• Stuart ME, Strite SA. British Medical Journal Rapid Response: Corticosteriods are Not Proven for Treatment of Bell's Palsy — response to Holland JN, Weiner GM, Recent developments in Bell's palsy. BMJ 2004;329:553-557 (4 September) Online

• “Their Job—Cure the Health Care Crisis”. Seattle Post Intelligencer newspaper interview by Seattle PI staff writer, Neil Modie, regarding King County Health Care Advisory Task Force’s strategies for improving quality and lowering costs in the Puget Sound region.
Feb. 19, 2004.

• Peer-reviewer for DynaMed ® DynaMed® is a registered trademark of and published by Dynamic Medical Information Systems, LLC – Irritable Bowel Syndrome (1/2004) and Rotator Cuff Tear (2/2004)

• Crittendon R, Stuart ME, Strite SA. “Promoting Better Quality and Decreasing Costs in Health Care.” White paper presented at 2003 Annual Health Care Conference – We Can’t Wait: Improving Washington’s Health. Rainier Institute. White Paper. (9/2003) [PDF] This policy proposal was aimed at establishing an evidence-based technology review committee and set of work processes for evaluating and determining evidence basis for new medications and technologies being considered by the purchasers of health care in the State of Washington.

• Braddick M, Stuart ME, Hrachovec J. “The Use of Balance Sheets in Developing Clinical Guidelines.” Geyman J, Deyo R, Ramsey S (Eds.), Evidence-Based Clinical Practice: Concepts and Approaches. Woburn, MA: Butterworth Heinemann, 1999.

• Braddick M, Stuart ME, Hrachovec J. “The Use of Balance Sheets in Developing Clinical Guidelines.” Journal American Board of Family Practice, Jan-Feb 1999, Vol. 12, No. 1, 48-54.

• Stuart ME, Macuiba J, Heidrich F, et al., Successful Implementation of an Evidence-Based Clinical Practice Guideline: Acute Dysuria/Urgency in Adult Women. HMO Practice. December 1997, 11(4):150-157.

• Strite SA, Stuart ME, Handley M, Braddick M. “Choosing Clinical Practice Guidelines,” White paper from Group Health Cooperative (1997).

• Strosahl K, Baker N, Braddick M, Stuart ME & Handley MR. “Integration of Behavioral Health and Primary Care Services: The Group Health Cooperative Model. In Cummings NA, Cummings JL & Johnson JN (Eds.), Behavioral Health in Primary Care: A Guide for Clinical Integration. Madison, CT: Psychosocial Press, in press.

• Stuart, M. “Changing Clinical Practice: Messages, Messengers, and Methods.” HMO Practice. September 1996;10(3): 100-102.

• Payne TH, Taplin SH, Savarino J, Galvin MS, Stuart M, Wagner E. Practicing population-based care in an HMO. HMO Practice, 1995;9:101-106.

• Thompson RS, Woolf SH, Taplin SH, Davis BV, Payne TH, Stuart ME, Wagner EH. “How to Organize a Large Health Care System for the Development and Delivery of Preventive Care Services.” In: Woolf Sh, Jonas S, Lawrence RS (Eds). US Preventive Services Task Force. Health Promotion and Disease Prevention in Clinical Practice, Chapter 23, Baltimore, Maryland, Williams & Wilkins, 1995.

• Thompson RS, McAfee TA, Stuart ME, Smith AE, Wilson J, Handley MR. A Review of Clinical Prevention Services at Group Health Cooperative of Puget Sound. American Journal of Preventive Medicine 1995;11(6):409-416.

• Handley MR, Stuart ME. “The Use of Prostate Specific Antigen for Prostate Cancer Screening: A Managed Care Perspective.” J Urology. November 1994; 152: 1689–1692.

• Thompson RS, Taplin SH, Davis BV, Payne TH, Stuart ME, Wagner EH. “How to Organize a Practice for the Development and Delivery of Preventive Care Services.” Chapter 24 in Health Promotion and Disease Prevention. In press.

• Handley MR, Stuart ME, Kirz HL. “An Evidence-Based Approach to Evaluating and Improving Clinical Practice: Implementating Practice Guidelines. ” HMO Practice. June 1994; 8(2): 75–83.

• Oshiro EA, Stuart ME. “Influencing Physician Behavior Change Through Participation in Evidence-Based Medicine Projects.” Proceedings of the Group Health Institute, June 1994, Miami Beach, Florida.

• Handley MR, Stuart ME. “An Evidence-Based Process for Evaluating and Improving Clinical Practice: Guideline Development.” HMO Practice. March 1994; 8(1): 10–19.

• Oshiro EA, Stuart ME. “International Volunteer Service: A Professional Satisfaction Project.” Proceedings of the Group Health Institute, June 1993, San Francisco, California.

• Stuart ME, Handley MR, Thompson RS, Conger M, Timlin D. “Clinical Practice and New Technology: Prostate-Specific Antigen (PSA). ” HMO Practice. Dec. 1992; 6: 11-19.

• Stuart ME, Handley MR, Conger MR. “Cancer of the Prostate.” Letter to the editor #LR 2130. JAMA. Dec. 1992.

• Stuart ME, Handley MR. “Prostate Screening May Do More Harm Than Good.” Letter in the Seattle Times, October 10, 1992.

• Stuart ME. “Current Literature Comments: PSA as a Screening Test.” HMO Practice. 1992; 6: 47.

• Oshiro EA, Stuart ME, Handley MR. “Just-in-time Continuing Medical Education.” Proceedings of the Group Health Association of America, 1992; 643-649.

• Oshiro EA, Stuart ME. “Just-in-time Continuing Medical Education.” Proceedings of the Group Health Institute, June 1992, San Francisco, California.

• Stuart ME, Handley MR. “What Men Should Know about the PSA Screening Test for Prostate Cancer.” GHC Center for Health Promotion Pamphlet Service, 1992.

• Stuart ME, Handley MR, Chamberlain MA, Wallach RW, et al. “Successful Implementation of a Guideline Program for the Rational Use of Lipid-Lowering Drugs.” HMO Practice. Nov./Dec. 1991; 5(6): 198-204.

• Handley MR, Stuart ME. “An Enlightened Approach to Cardiac Risk Management. ” GHC Medical Forum. 1991; 5: 4-8.

• Thompson RS, Taplin SH, McEvoy JP, Sailer JF, Stuart ME, Green BB, Kelly MM, Wagner EH. “Prostate-Specific Antigen: A Useful Screening Test?” GHC Medical Forum. 1991; 5: 17-18.

• Scheingold LD, Stuart ME. “The Art of Medicine Seminars.” HMO Practice. Dec. 1988; 2(6): 225-230.

• Oshiro EA, Stuart ME. “Practice Management Seminars in an HMO.” Proceedings of Group Health Association of America, June 1988.

• Sheingold LD, Stuart ME. “The Art of Medicine Seminars for Practicing Physicians.” Mobius, the Journal of Continuing Education for Health Science Professionals. July 1987; 27-31.

• Stuart ME, Oshiro EA. “Eleven Elements in the Successful Medical Encounter.” Proceedings of the Group Health Association of America, June 24, 1987.

• Oshiro EA, Stuart ME. “The Art of Medicine. ” Proceedings of the Group Health Association of America, June 23, 1987.

• Miller JW, Stuart ME, Titus JS, Hill LD, Beebe HG. “Gluteal Artery Aneurysm: Case Report.” Journal Bone Joint Surgery. April 1974; 56a: 620-622.