The MEDLINEplus section HealthTopics provides users with access to pre-formulated MEDLINE searches on common topics, most of which are diseases or conditions. The topics included were identified through an analysis of the most common search terms used on the NLM home page, which revealed that 90 percent or more were for specific diseases, conditions, or other common medical terms (e.g., Viagra, St. John’s Wort) (Miller et al., 2000). The HealthTopics list numbers more than 300, with some of the most frequently searched topics being diabetes, shingles, prostate, hypertension, asthma, lupus, fibromyalgia, multiple sclerosis, and cancer.

There are many other sources of filtered evidence-based information as well, including the Cochrane Library discussed above. Access to evidence-based guidelines is provided in the United States by the National Guideline Clearinghouse (sponsored by the Agency for Healthcare Research and Quality), the American Medical Association, and the American Association of Health Plans (Agency for Healthcare Research and Quality et al., 2000), and in Canada by the CPG Infobase (sponsored by the Canadian Medical Association) (Canadian Medical Association, 2000). NOAH (New York Online Access to Health) is a library collaboration for bilingual consumer health information on the Internet (Voge, 1998).

Thus many efforts are under way to assist users in accessing useful health care information on the Web. Some believe, however, that much more could be done to achieve a more “powerful and efficient synergy” between the Internet and evidence-based decision making (Jadad et al., 2000a).

DEFINING QUALITY MEASURES

The enhanced interest in and infrastructure to support evidence-based practice have implications for quality measurement, improvement, and accountability (Eisenberg, 2000b). The use of priority conditions as a framework for organizing the evidence base, as discussed in Chapter 4, may also have implications for external accountability programs.

Systematic reviews and practice guidelines provide a strong foundation for the development of a richer set of quality measures focused on medical care processes and outcomes. To date, a good deal of quality measurement for purposes of external accountability has focused on a limited number of “rate-based” indicators—rates of occurrence of desired or undesired events. The National Committee for Quality Assurance, through its Health Plan Employer Data and Information Set, makes comparative quality data available on participating health plans and includes such measures as childhood immunization rates, mammography rates, and the percentage of diabetics who had an annual eye exam (National Committee for Quality Assurance, 1999). The Joint Commission on the Accreditation of Healthcare Organizations sponsors the ORYX system for hospitals, which includes measures such as infection rates and postsurgical complication



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