Hartzband and Groopman on the Rise of the Medical Expertocracy – WSJ.com

April 2, 2012

Democrats and Republicans share a fundamental misconception about medical care. Both assume that, as in mathematics, there is a single right answer for every health problem. These “best practices,” they believe, can be found by gathering large amounts of data for experts to analyze. The experts will then identify remedies based strictly on science—impartial and objective.

Yet in medicine, there are many contrary opinions about “best practices.” You cannot pick up a newspaper, turn on the TV or surf the Internet without encountering conflicting reports about various tests and treatments. Medical experts disagree about many issues, often dramatically.

via Hartzband and Groopman on the Rise of the Medical Expertocracy – WSJ.com.


Medicine must allow for customization: A lesson for policymakers — and regulators – Health – AEI

April 2, 2012

As appealing as it is – as useful as it is – to imagine that there exists a gold-standard way to practice medicine, and a single-best way to approach most human ailments, the reality is considerably more complex and messy, as Hartzband and Groopman’s (continued) critique of so-called “best practices” makes clear.

The heart of their argument is this: “For patients and experts alike, there is a subjective core to every medical decision. The truth is that, despite many advances, much of medicine still exists in a gray zone where there is not one right answer. No one can say with certainty who will benefit by taking a certain drug and who will not. Nor can we say with certainty what impact a medical condition will have on someone’s life or how they might experience a treatment’s side effects. The path to maintaining or regaining health is not the same for everyone; our preferences really do matter.”

via Medicine must allow for customization: A lesson for policymakers — and regulators – Health – AEI.


White Coats and Straightjackets: Why Planned Cost-Saving Measures Will Reduce Your Healthcare Options — The American Magazine

March 7, 2012

Before we proceed with the Independent Payment Advisory Board, we should carefully consider the pernicious impact that similar structures have had on patient care.

via White Coats and Straightjackets: Why Planned Cost-Saving Measures Will Reduce Your Healthcare Options — The American Magazine.


There Is No Objective Definition of ‘Medical Necessity’ | Cato @ Liberty

March 5, 2012

So the question becomes: who will do a better job of deciding whether and when hip replacements or antibiotics or Viagra are “medically necessary?” Regulators? Or patients choosing health plans (in part) based on how those plans define medical necessity?

via There Is No Objective Definition of ‘Medical Necessity’ | Cato @ Liberty.


Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm — NEJM

March 2, 2012

The largest U.S. health insurer, the Centers for Medicare and Medicaid Services (CMS), has set a triple aim: better care for individuals, better health for populations, and lower costs. Simultaneously, major efforts have been launched to make care more patient-centered, defined as “respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.”1 Attention to patient-centered measures and outcomes will be particularly important as CMS moves increasingly to link health care providers’ reimbursement to their performance on selected measures.

So far, assessments of quality of care and health outcomes have not incorporated patient-centeredness. Rather, measurement of quality has addressed preventive and disease-specific care processes (e.g., smoking-cessation counseling and initiation of appropriate medications after myocardial infarction). Similarly, outcomes measurement has focused on condition-specific indicators, both short-term (e.g., glycated hemoglobin levels and hypertension control) and longer-term (e.g., disease-free survival), as well as overall mortality.

via Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm — NEJM.


Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm — NEJM

March 1, 2012

An alternative approach to providing better care would be to focus on a patient’s individual health goals within or across a variety of dimensions (e.g., symptoms; physical functional status, including mobility; and social and role functions) and determine how well these goals are being met (see table). For example, a person with Parkinson’s disease may establish goals for symptoms, such as decreased rigidity and no falls; goals for functional status, such as the ability to get to the bathroom without assistance although requiring a walker; and goals for social function, such as the ability to use the Internet to communicate with a grandson at college and the ability to go to church. However, the patient may not be aiming to reduce tremor, walk without a walker, or continue to work for pay. Alternatively, he or she may prioritize being as mobile as possible even at the expense of medication-induced dyskinesia and mild confusion.

via Goal-Oriented Patient Care — An Alternative Health Outcomes Paradigm — NEJM.


Building Health Reform’s Research Arm – Kaiser Health News

January 10, 2012

PCORI is not quite a household name, but if Dr. Anne Beal has her way, it will be soon. The acronym stands for Patient Centered Outcomes Research Institute—a group of doctors, researchers, statisticians and patient advocates who will commission evidence-based research for the health care system. The goal, according to Beal, is to provide easy-to-understand information to patients so they can make the most informed health care decisions.

The quasi-governmental institute is partially funded through a $1-per-enrollee fee on certain insurers; the fee increases to $2 per person in 2013. It is enforced by the I.R.S. The new organization and its financing drew an attack this week from the Senate Republican Policy Committee. According to the committee’s blog, this fee “represents a complete turnaround from an Administration that campaigned against taxing health benefits.”

via Building Health Reform’s Research Arm – Kaiser Health News.


The Patient Protection and Affordable Care Act of 2010 (PL 111-148)

January 8, 2012

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act, setting in motion a historic and, for many, a long-awaited radical change to the current American health care system. Section 2951 of the PPACA addresses provision and funding of maternal, infant, and early childhood home visiting programs. The purpose of this article is to acquaint the reader with the legislative odyssey of home visitation services to at-risk prenatal and postpartum women and children as delineated in the PPACA and to discuss the nursing practice and research implications of this landmark legislation. Few question the need for more rigorous methodology in all phases of home visitation research. Public health nursing may provide the comprehensive approach to evaluating effective home visitation programs.

via The Patient Protection and Affordable Care Act of 2010 (PL 111-148).


Sentinel Active Surveillance Roundtable: Multi-Payer Claims Database – Brookings Institution

November 9, 2011

The American Recovery and Reinvestment Act of 2009 (ARRA) made possible substantial investments in comparative effectiveness research (CER), particularly in the areas of improving the data infrastructure and methods for research. As part of these investments, the Assistant Secretary for Planning and Evaluation (ASPE) within the U.S. Department of Health and Human Services (HHS) has been collaborating with the Centers for Medicare and Medicaid Services, OptumInsight, and other healthcare industry and research leaders to develop a Multi-Payer Claims Database (MPCD), which is envisioned as an important new resource for CER.

via Sentinel Active Surveillance Roundtable: Multi-Payer Claims Database – Brookings Institution.


New edition of “Testing Treatments”, best pop science book on Evidence Based Medicine ever. – Bad Science

November 3, 2011

People often ask if there’s one good book that is accessible to all, about how evidence based medicine works. The answer is undoubtedly “Testing Treatments“. I name-check it to death in Bad Science, I learnt a huge amount from it, and it’s just come out in a new edition. You can (generously!) download the full text as a PDF for free here, and there are translations in various languages for free on that page too. I recommend getting a paper copy (they’re lovely and it’s very readable) here, there’s a proper Kindle edition here, and the publisher page is here. Meanwhile a website version with extra resources is coming shortly.

I genuinely, truly, cannot recommend this awesome book highly enough for its clarity, depth, and humanity.

via New edition of “Testing Treatments”, best pop science book on Evidence Based Medicine ever. – Bad Science.