Healthcare Decision Support Part 2: Evidence-Based Medicine

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Healthcare reform is helping to shape a more informed individual in every role they play as healthcare consumers: employees, insurance policyholders, and patients. People are becoming more engaged in all aspects of their heath care—from choosing the most appropriate health plan and managing healthcare dollars to working with their doctors to make medical care decision. They are also learning to navigate the system with help from healthcare decision support tools, as we explored in part 1 of this article series. When it comes to pursuing treatment options for medical conditions, they just might turn to evidence-based medicine to direct their decisions.

Evidence-Based Medicine

Evidence-based medicine (EBM), also called evidence-informed or evidence-based healthcare, combines clinical expertise with research-based information upon which to make medical treatment decisions. This trend in healthcare decision support has been gaining momentum thanks to the Patient Protection and Affordable Care Act, which mandates a national comparative outcomes research project agenda as an effort to advance the quality of healthcare—while ultimately helping to reduce costs and improve outcomes.

To this end, the non-governmental Patient-Centered Outcomes Research Institute (PCORI) was created as part of the PPACA to fund research aimed at helping patients make informed decisions. Funded in part by the Patient-Centered Outcomes Research Trust Fund fee paid by issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans, the PCORI has approved 197 awards totaling more than $273.5 million to date. Examples of research by priority area:

  •  Improving Healthcare Systems: Patient Navigator to Reduce Readmissions (PARTNER), University of Chicago
  •  Assessment of Prevention, Diagnosis and Treatment Options:  Ovarian Cancer Patient-Centered Decision Aid, University of California Irvine
  •  Addressing Disparities: Rural Options at Discharge Model of Active Panning (ROADMAP), University of Montana
  •  Accelerating PCOR and Methodological Research: Facilitating Patient Reported Outcome Measurement for Key Conditions, Dartmouth College
  •  Communication and Dissemination Research: Shared Medical Decision Making in Pediatric Diabetes, Nemours Children’s Clinic

Amassing research pertaining to the clinical effectiveness and appropriateness of various treatments, healthcare delivery models, and other factors is expected to benefit the entire healthcare community, providing a growing bank of information to be used in myriad ways. Critics of the ACA’s pursuit of a healthcare system that relies on evidence-based medicine fear that it promotes the standardization of treatment and reduces the “personalization” of care that exists between doctor and patient (see this Forbes article  for commentary). However, it can be argued that clinicians and patients can make better decisions when they have access to unbiased, relevant research insights.

This may lead to reduced waste in the form of unnecessary procedures and testing, or from choosing costly treatments that have equally effective, yet less costly, alternatives. If doctors lack evidence they need to consider alternatives, they might fall back to doing what’s customary. Evidence-based medicine, therefore, can be used to redefine “usual and customary” or “reasonable and necessary” standards, ultimately impacting treatment and cost trends.

Convincing physicians to start employing evidence-based medicine in their patient care process is one of the challenges facing proponents of the practice. In her article Using Comparative-Effectiveness Research to Improve Care in Hosptials & Health Networks digital magazine, Vivian Ho, PhD, chair of health economics at Rice University’s Institute for Public Policy and professor at Baylor College of Medicine in Houston, suggests that “the most important task for the health care industry is to educate medical practitioners at every stage of their careers about new findings…to ensure that this information influences physicians’ recommendations and directly benefits patients.” 

Check out Part 1 of the Healthcare Decision Support series: Tools to Use if you missed it. And stay tuned for the final article in this series, which delves into the trend of shared decision-making.

 

 

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