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OCR for page 10
Critical Factors in the Discussion of
Clinical Conditions
In recommending clinical problem areas for further investigation, we
considered the factors listed below. We also assumed that these criteria will
be used during further refinement of the list of clinical conditions and
selection of specific conditions:
high prevalence of We illness in the elderly population andJor in
particular subgroups of the elderly;
2. burden of the illness on We elderly, characterized by, for instance,
whether it is life-threatening, likely to produce major impairment and
disability, or likely to pose a serious decrement to We person's health,
well-being, and independence;
3. substantial variation across geographic areas in We per-person use
of services for the condition (i.e., variation beyond that explained by
differences in patient characteristics or health resources in the areas);
4. substantial variation across geographic areas or institutions in the
outcomes of care for We condition (i.e.. variation beyond that explained by
the differences in We severity of illness or sociodemographic characteristics
of patients);
5. relatively high costs (to the Medicare program l) of reimbursing for
the services provided to patients to diagnose and treat the condition;
6. alternative strategies for managing the care of patients with We
condition that are in dispute or reflect professional and clinical uncertainty;
and
7. reasonable availability of data to address key effectiveness ques-
tions, either through HCFA's existing (or anticipated) administrative files
or through special studies, surveys, and patient follow-up activities.
10
OCR for page 11
11
In addition, we believe that three other areas of concern should receive
attention in the Effectiveness Initiative: screening and prevention of illness;
the mental and emotional dimensions (anxiety and depression; cognitive
functioning) of any illnesses selected for in-depth study; and clarification
of the differences between efficacy and electiveness. We are especially
concerned that special attention be given to the generation and use of reliable
and valid outcome measures that relate to functional status and quality of
life.
Furthermore, we want to stress the importance of contributions that
specific studies on particular kinds of illnesses can provide as prototypes
for ways to examine other problems. Thus, we have sought to identify acute
illnesses, chronic diseases, and ailments treated by surgery or over proce-
dures that could be considered relatively "clear-cut" i.e., readily identif~-
able, with straightforward etiologies, relative homogeneity of diagnosis,
and clear clinical endpoints. The committee also emphasizes the impor-
tance of selecting at least one condition or problem area about which greater
ambiguity exists in terms of the ease of defining the condition or specifying
the etiology. Hence, we recommend selecting one problem area with
heterogeneity of diagnosis and less clear endpoints.
Representative terms from entire chapter:
functional status
