Knowing What Works in Health Care A Roadmap for the Nation (2008) / Chapter Skim
Currently Skimming:
2 An Imperative for Change
2 An Imperative for Change
Pages 33-56
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 33... ...
Unwarranted variation in clinical practice reflects deviations from accepted standards of care, as well as uncertainty and disagreement regarding what those standards should be. This contributes to the health care quality chasm in which patients cannot always be assured that they will receive the best, most effective care.
|
From page 34... ...
However, significant gaps in the ability to develop, synthesize, and apply the evidence on clinical effectiveness remain; and the nation faces major challenges as an array of new -- and often very expensive -- technologies and treatments rapidly enter the health care marketplace. As a result, the nation needs to continue to improve its capacity to assess clinical effectiveness and ensure that health care decision making is grounded in the evidence about what works.
|
From page 35... ...
. The evidence base for clinical effectiveness has thus become so vast that it is essentially unmanageable for individual providers (IOM, 2001)
|
From page 36... ...
PERSISTENT HEALTH POLICY CHALLENGES Clinical effectiveness is a central issue in health care. Improving the capacity to conduct clinical effectiveness assessments has the potential to improve health care in a range of vital areas, from cost to quality and access.
|
From page 37... ...
concludes that rising health care costs pose a fiscal challenge not just to the federal budget but also to states, American businesses, and society as a whole. The federal Medicare program spent $374 billion in 2006 and accounted for 13 percent of all federal spending (Kaiser Family Foundation, 2007)
|
From page 38... ...
. Overall, the difference in lifetime Medicare spending between a typical 65-year-old in Miami, Florida, and one in Minneapolis, Minnesota, has been estimated to be more than $50,000 (Wennberg et al., 2002b)
|
From page 39... ...
. Consequently, differentiating between effective and ineffective health utilization is an important policy objective.
|
From page 40... ...
As a result, many policy makers have called for the establishment of a national organization that would be able to meet the need for clinical effectiveness information (America's Health Insurance Plans, 2007; BCBSA, 2007a; Medicare Payment Advisory Commission, 2007; Shortell et al., 2007; Wilensky, 2006)
|
From page 41... ...
. CURRENT LANDSCAPE Providers, patients, health plans, and others need information about clinical effectiveness to ensure that the decisions that they make are solidly grounded in the evidence about what works.
|
From page 42... ...
Key Players A number of public- and private-sector organizations are involved in the collection, analysis, and dissemination of clinical effectiveness information. In addition to the NIH and the private-sector groups that fund primary research, many other organizations are involved in assessing that information and synthesizing it in ways that inform decision making.
|
From page 43... ...
Individuals and organizations use the syntheses of the available evidence that these organizations produce in a number of ways. Public and private health plans use the information to inform their coverage decisions, professional and patient care organizations use the information to create practice guidelines, organizations that track provider performance rely on it to establish benchmarks of appropriate care, and the information is also
|
From page 44... ...
TEC is a designated EPC, and its products are publicly available on its website. Cochrane The Cochrane Collaboration is an independent, nonprofit organization that Collaboration produces and disseminates systematic reviews of health care interventions.
|
From page 45... ...
The CDP produces consensus statements not intended to serve as practice guidelines. NOTE: CDP = Consensus Development Program; DERP = Drug Effectiveness Review Project; MCAC = Medicare Coverage Advisory Committee; MedCAC = Medicare Evidence Development and Coverage Advisory Committee.
|
From page 46... ...
ACP In 1981, the ACP launched the Clinical Efficacy Assessment Project to evaluate advances in medicine and develop clinical practice guidelines based on the best evidence available. Current guidelines are based on evidence reports commissioned by AHRQ and produced by EPCs.
|
From page 47... ...
Performance Measurement Organizations A number of organizations track and evaluate provider performance by measuring their actual clinical practices against the recommended practices (Table 2-4)
|
From page 48... ...
NCQA A nonprofit organization founded in 1990, the NCQA accredits health organizations to provide consumers and employers with an indicator of quality. The NCQA develops quality standards and performance measures, building consensus among large employers, policy makers, physicians, patients, and health plans to decide what aspects of quality to measure, how to measure it, and how to promote improvement.
|
From page 49... ...
. Inconsistent Coding The organizations that provide systematic reviews and clinical guidelines use different grading systems to characterize the quality of evidence and the strength of recommendations.
|
From page 50... ...
One large study found that 87 percent of the clinical practice guidelines did not say whether a systematic search for published studies had been conducted (Grilli et al., 2000)
|
From page 51... ...
The list of organizations that add their voice is long and diverse: professional societies, individual physicians, health plans and purchasers, patients and consumer advocacy groups, producers of consumer decision aids, trade associations, manufacturers, public and private systematic reviewers, health services researchers, universities, think tanks, consultancy groups, Medicare contractors, federal regulators, NIH panels, state and federal policy makers, state and federal courts, and even the media. Not surprisingly, this often results in a cacophony of voices that in the
|
From page 52... ...
Washington, DC: America's Health Insurance Plans. American Diabetes Association.
|
From page 53... ...
2007b. Medicare Evidence Development & Coverage Advisory Committee http:// www.cms.hhs.gov/FACA/02_MedCAC.asp#TopOfPage (accessed March 2, 2007)
|
From page 54... ...
Bethesda, MD: American College of Cardiology/American Heart Association Task Force on Practice Guidelines. ECRI Institute.
|
From page 55... ...
2001. Use of systematic reviews in clinical practice guidelines: Case study of smoking cessation.
|
From page 56... ...
2006. Consumer-directed health plans: Small but growing enrollment fueled by rising cost of health care coverage.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.