ties currently under way at the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).

This chapter begins by setting the context for the committee’s consideration of CAM on the basis of a more general model of health care decision making.

CONTEXT

Questions about CAM use arise at a time when providers of conventional medical care are being challenged as never before to examine the effectiveness and efficiency of health care in the United States. The Institute of Medicine’s (IOM’s) Crossing the Quality Chasm (IOM, 2001) provides ample evidence for the underuse of effective care, the overuse of marginally effective or ineffective care, and the misuse of care, including preventable errors, in its delivery. Widespread variation in rates of surgery and other interventions for common conditions among seemingly similar populations in different geographic regions raises concern about how doctors and patients make decisions.

The Crossing the Quality Chasm report concludes that fragmentary, incremental change will be insufficient to reach achievable levels of quality improvement in American health care. Fundamental redesign will be required, and the report offers 10 rules for redesign. Taken together, these suggestions advocate a systems-minded approach to making health care more knowledge based and patient centered.

This report is about CAM, not about the quality of conventional medicine or the way in which it is delivered. However, as will be seen, central to the definition of CAM is that its constituent elements are “other than” conventional medicine. Therefore, an appreciation of both the strengths and the limitations of conventional medicine, especially as perceived by CAM users in the United States, is necessary context for development of conceptual models to guide public and private decision making about CAM research and practices.

The principal conceptual model that the committee used to frame this report begins with the question, What do patients and health professionals need to know to make good decisions about the use of health care interventions, including CAM? Corollary questions for policy makers relate to the research necessary to support decisions as well as policies and resources to ensure the quality and efficiency of services as well as equitable access. The more general nature of the question and its corollaries, addressing health care interventions rather than CAM interventions alone, reflects the committee’s view that the decision-making needs of stakeholders in the American health care economy are equivalent for conventional and CAM health care services.



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