Evidence-Based Medicine and the Changing Nature of Health Care 2007 IOM Annual Meeting Summary (2008) / Chapter Skim
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1 The Changing Nature of Health Care
1 The Changing Nature of Health Care
Pages 33-48
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From page 33... ...
The innovation underlying such progress continues to advance and accelerate change, while many new technologies and medical interventions provide new options for care and treatment. B etween 1991 and 2003, for example, the number of medical device patents per year doubled (AdvaMed, 2004)
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From page 34... ...
Systems of care, historically devoted to the prevention and treatment of infectious diseases and discrete episodes of acute care, are now increasingly occupied with the management of chronic health conditions such as heart disease, diabetes, and asthma. In fact, half of those reporting a chronic illness suffer from more than one (Wu and Green, 2000)
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From page 35... ...
To orient our existing expertise and emerging resources towards improved development and application of evidence in health care, a broad view of the changing nature of health care and implications for capacity and necessary cultural change is needed. The challenges to creating an evidence-driven healthcare system are great, but so, too, is the potential reward: affordable health care, based on evidence of what works that improves health outcomes for individual patients.
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From page 36... ...
Roundtable activities focus on accelerating the development of a learning healthcare system; expanding the capacity to generate evidence on medical care that is the most effective and produces the greatest value; and improving public understanding of the nature, importance, and dynamic character of medical evidence. The IOM convenes annual meetings dedicated to the examination of topical and critical issues in health care and health policy.
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From page 37... ...
Better disease models and evidence relevant to the treatment of individual patients is lacking, despite publications and news stories that seem to suggest otherwise. Also, much of the current data are not from traditional randomized controlled trials (RCTs)
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From page 38... ...
Needed are new approaches to the evaluation and adoption of medical best practices, new methods for drawing appropriate conclusions from vastly expanded data resources, and new approaches for using evidence to improve care and
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From page 39... ...
For consumers, access to care is a priority but an additional, emerging challenge will be to ensure that incentives for research and care are properly aligned to support care focused on individual patient needs, circumstances, and preferences. The very nature of patient-physician relationships is also undergoing a rapid change as healthcare data are increasingly captured and made available in various forms through IT.
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From page 40... ...
Federal agencies, such as the National Institutes of Health, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, the Department of Defense, the Veterans Health Administration, the Centers for Disease Control and Prevention, and others, will be essential components of this dialogue and can demonstrate leadership by partnering across agencies, as well as with others in the private sector. Healthcare product developers in particular will be absolutely critical to the success of EBM, and collaborations that take advantage of this sector's talent and expertise can be facilitated and encouraged through public-private partnerships.
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From page 41... ...
As outlined in Chapters 2 and 3, these forces include rising and unsustainable costs, wide variations in the quality and cost of health care delivered across the United States, and the complexity of care introduced by the emerging insights from genetic research and the diversity of new health products. Contending with the Changes Michael M
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From page 42... ...
Rowe, M.D., Mailman School of Public Health, Columbia University A learning healthcare system is defined as one in which the usual and customary activities associated with the production, distribution, utilization, and financing of healthcare services result in the simultaneous development and capture of data that are essential to the monitoring and evaluation of health care delivered. A wide variety of information is contained in these data including, but not necessarily limited to, patient characteristics (e.g., genetics, race, ethnicity, socioeconomic status, behaviors, clinical conditions, functional status)
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From page 43... ...
As emphasized in Chapter 2, attention is needed on the evaluation of drugs, devices, and procedures, as well as on systems of care and the healthcare professionals that are involved in the provision of the care. One of the major strategies proposed to hasten development of the r equired evidence base includes migration away from traditional reliance on RCTs and inclusion of a variety of other approaches and data sources.
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From page 44... ...
Session 1 (Chapters 2 and 3) reviewed the need for better medical evidence, characterizing not only the waste and inefficiency endemic to health care and the unsustainable trajectory of healthcare expenditures, but also the challenges presented by medical technologies of increased diversity and complexity and an increasingly sophisticated understanding of genetic contributions to disease.
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From page 45... ...
More and better evidence -- including comparative and longitudinal data -- is needed to deter mine the effectiveness and usefulness of new medical interventions, treatments, drugs, devices, and genetic information. There is an untapped potential to reduce healthcare costs and improve quality by developing evidence not only for specific medical interventions, but also for the way health care is delivered.
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From page 46... ...
To develop best evidence for the delivery of medicine that is geared toward the needs of indi vidual patients, investment is needed into infrastructure for the gathering and analysis of healthcare data and information, as well as standards and protocols to ensure their accuracy and reliability. This changing role will require healthcare providers and patients to adopt a culture that supports the generation and application of evidence.
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From page 47... ...
2007a. The learning healthcare system: Workshop summary.
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