Strengthening the Evidence Basis for Best Practice Guidelines and Quality Standards

Despite our health system’s many challenges and the significant increase in our population’s health risk factors related to the obesity epidemic, clinical outcomes have significantly improved in recent years across a range of conditions, such as cardiovascular disease and many cancers. Ongoing medical innovation provides the potential to continuously improve medical outcomes and increase health care value. For example, the progress being made in genomics and related fields toward personalized medicine holds promise for creating more useful and individualized tools for predicting susceptibility to disease, disease prevention, and targeting of treatments more precisely to each patient based on genetic information and other factors.

At the same time, the U.S. healthcare system suffers from well-documented system-wide problems of sub-optimal quality and value of care. The United States spends more money per capita than any other industrialized nation, but evidence shows U.S. patients routinely fail to receive recommended treatment and care. Landmark studies by the RAND Corporation have found that adults in the United States receive recommended care only a little over half the time (54.9%), and children received just 47% of recommended care overall and only 41% of recommended preventive service.

To get better value from our health spending we need a better understanding of what works, for whom, under what conditions, and why. Then, we need to develop standards based on evidence and consensus, and encourage medical practitioners to provide care based on those standards.

Following are recommendations to aid in the development of evidence-based standards for effective preventive care, disease treatment and delivery of health services:

  1. Establish and fully fund a national center focused on research regarding comparative effectiveness of alternative disease prevention and clinical treatment interventions. An independent, national entity should be established and provided with gaps sustained, sufficient funding to address significant in evidence about “what works” in health care and improve the quality of patient care. To have a meaningful impact on improved health care value, while informing patient and physician decisionmaking from a range of health care options, such research should examine the full range of medical technologies and care delivery and management.

    For example, comparative effectiveness research can help reduce wide, inappropriate geographic variation in health care costs, which leads to an estimated $700 billion in wasteful spending, but only if it examines the range of factors that drive this variation – including evidence gaps related to medical technology, care delivery, management and organization.

    Similarly, the national center should also undertake health services research that promotes greater understanding of the wide range of factors (such as financial incentives, use of health information technology, health management and organization) that affect the translation of evidence into practice and whether patients receive evidence-based care.

  2. Develop evidence-based standards and quality measures for reporting. Quality measures should continue to be developed through a clinically-based consensus process with the best available clinical and scientific evidence. Quality reporting based on these consensus-standards should be implemented in all federally funded or supported programs.

    Quality measures should be validated as achieving measurable, meaningful improvements in patient outcomes (for example, measures that encompass complete episodes of care), not simply drive changes in infrastructure or processes of care.

Despite our health system’s many challenges and the significant increase in our population’s health risk factors related to the obesity epidemic, clinical outcomes have significantly improved in recent years across a range of conditions, such as cardiovascular disease and many cancers. Ongoing medical innovation provides the potential to continuously improve medical outcomes and increase health care value. For example, the progress being made in genomics and related fields toward personalized medicine holds promise for creating more useful and individualized tools for predicting susceptibility to disease, disease prevention, and targeting of treatments more precisely to each patient based on genetic information and other factors.

At the same time, the U.S. healthcare system suffers from well-documented system-wide problems of sub-optimal quality and value of care. The United States spends more money per capita than any other industrialized nation, but evidence shows U.S. patients routinely fail to receive recommended treatment and care. Landmark studies by the RAND Corporation have found that adults in the United States receive recommended care only a little over half the time (54.9%), and children received just 47% of recommended care overall and only 41% of recommended preventive service.

To get better value from our health spending we need a better understanding of what works, for whom, under what conditions, and why. Then, we need to develop standards based on evidence and consensus, and encourage medical practitioners to provide care based on those standards.

Following are recommendations to aid in the development of evidence-based standards for effective preventive care, disease treatment and delivery of health services:

  1. Establish and fully fund a national center focused on research regarding comparative effectiveness of alternative disease prevention and clinical treatment interventions. An independent, national entity should be established and provided with gaps sustained, sufficient funding to address significant in evidence about “what works” in health care and improve the quality of patient care. To have a meaningful impact on improved health care value, while informing patient and physician decisionmaking from a range of health care options, such research should examine the full range of medical technologies and care delivery and management.

    For example, comparative effectiveness research can help reduce wide, inappropriate geographic variation in health care costs, which leads to an estimated $700 billion in wasteful spending, but only if it examines the range of factors that drive this variation – including evidence gaps related to medical technology, care delivery, management and organization.

    Similarly, the national center should also undertake health services research that promotes greater understanding of the wide range of factors (such as financial incentives, use of health information technology, health management and organization) that affect the translation of evidence into practice and whether patients receive evidence-based care.

  2. Develop evidence-based standards and quality measures for reporting. Quality measures should continue to be developed through a clinically-based consensus process with the best available clinical and scientific evidence. Quality reporting based on these consensus-standards should be implemented in all federally funded or supported programs.

    Quality measures should be validated as achieving measurable, meaningful improvements in patient outcomes (for example, measures that encompass complete episodes of care), not simply drive changes in infrastructure or processes of care.

Contents

Restructuring Incentives

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