National Priorities for the Assessment of Clinical Conditions and Medical Technologies Report of a Pilot Study (1990) / Chapter Skim
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3 Twenty Priority Assessment Areas
3 Twenty Priority Assessment Areas
Pages 27-54
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From page 27... ...
Most of He phony clinical conditions are prevalent in me adult and elderly patient population. In addition, two priority clinical conditions (breast cancer and pregnancy)
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From page 28... ...
Assessments conceming breast cancer would have the potential to do the following. Improve Individual Patient Outcome The 5-year survival rate for women with breast cancer is 60 percent (American Cancer Society, 1989~.
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From page 29... ...
Reduce Unexplained Variations in Medical Practice Practice styles vary widely among physicians who treat and try to prevent breast cancer (Rebrnan, 1989~. For instance, variations have been reported in the use of procedures such as breast biopsy (Wennberg, 1984; Roos et al., 1988; McMahon et al., 1989)
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From page 30... ...
In addidon, cataract extraction is He most common of aU major and minor surgical procedures among Medicare beneficianes, with between I.2 mildion and I.6 million performed annually (Helloing and Keene, 1989a; Stark et al., 1989~. Reduce Unit or Aggregate Cost The annual cost of cataract surgery and the associated visual rehabilitation has been estimated to be over $2.5 billion (National Advisory Eye Council, 1987~.
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From page 31... ...
Improve Individual Patient Outcome Despite the poor prognosis of this disease, more elective management of COPD may improve the quality of life of patients whose severe shortness of breath often Innits their daily activities. Affect a Large Patient Population COPD is Be fifth leading cause of death In Be United States, claiming more man 70,000 lives each year (Amencan Cancer Society, 1989~.
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Improve Individual Patient Outcome Tltis clinical condition results in a high degree of modality, morbidity, and disability; it can severely limit a pa~dent's activity, independence, and quality of life (Amencan Heart Association, 1989~.
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From page 33... ...
Reduce Unit or Aggregate Cost Interventions associated with the diagnosis and treatment of coronary array disease and lost productivity as a result of this clinical condition cost the United States almost $80 billion in 19g6 (Amencan Heart Association, 19X9~. Reduce Unexplained Variations in Medical Practice Geographic variations in the incidence of hospitalization have been documented for chest pain, angina pectons, acute myocardial infarction, and major cardiovascular operations (Wennberg, 1984; Roos et al., 19X8; McMahon et al.
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From page 34... ...
Advance Medical Knowledge As new technologies for gallbladder disease emerge, new enters to guide the selection of the best therapy for individual patients need to be developed. Gastrointestinal Bleeding This clinical condition refers to bleeding from the upper or lower gastrointestinal (Gb tract from causes such as peptic ulcer disease or malignancy (especially colorectal and stomach cancer)
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From page 35... ...
bleeding have the potential to do the following. Improve Individual Patient Outcome Gastrointestinal bleeding can cause weakness, exacerbations of cardiovascular disease, and death Mortality in hospitalized patients with upper gastrointestinal bleeding is approximately 10 percent (Peterson, 1988~.
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From page 36... ...
Improve Individual Patient Outcome AIDS is an incurable fated disease whose man~festabons range from weight loss and fatigue to AIDS dementia, life-threatening secondary infections, and malignancies. The psychologic, emotional, and physical effects of AIDS am devastating.
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From page 37... ...
Reduce Unexplained Variations in Medical Practice Treatment of AIDS varies widely, especially across geographic areas, with regard to the use of Inpatient hospital services and self-help activities of affected groups (Sisk, 197. Advance Medical Knowledge Many aspects of the pa~ogenesis and clinical manifestations of this disease are not wed understood.
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From page 38... ...
Improve Individual Patient Outcome loins disease can cause pain and immobility of Me upper and lower limb joints, which In turn greatly diminishes quality of life, work productivity, and functional independence. Affect a Barge Patient Population Osteoarthritis and rheumatoid arthritis afflict 15.8 million and 2.} million Americans, respectively Antis Foundation, 1989~.
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From page 39... ...
Assessments concerning low back pain would have the potential to do the following. Improve individual Patient Outcome Low back pain is the most likely cause of activity limitation and absence from work in persons less than 45 yeam old (Svensson and Andersson, 1982; Flymoyer, 1988~.
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estimate that an annual welfare loss of $280 minion is associated with van ations ~ medical practice related to medical back problems. Advance Medical Knowledge Knowledge about the biologic causes of low back pain is incomplete.
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. Reduce Unexplained Variations in Medical Practice The use of hip fracture repair operations has been shown to vary sigruficandy by geographic region (Chass~n et al., 1986)
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From page 42... ...
Assessments concerning pregnancy would have the potential to do the following. Improve Individual Patient Outcome A premature or low-birthweight infant is almost 40 times more likely to die in the neonatal period than an infant born at full tenn and with a nonnal birthweight (Shapiro et al., 19gO)
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Assessments conceding prostatism wood have He potential to do the following. Improve Individual Patient Outcome More effective management of prostatism may improve He quality of life of many patients who experience unnaly tract pain, obstruction, and infection.
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Assessments concerning psychiatric disorders would have the potential to do He following. Improve Individual Patient Outcome A patient with a psychiatric disorder can experience psychologic suffering, social maladjustment, physical debilitation, and family disruption.
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(Harwood et al., 1984~. Reduce Unexplained Variations in Medical Practice Phelps and Parente (1989)
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From page 46... ...
Assessments concerning substance abuse would have the potential to do the following. Improve Individual Patient Outcome The morbidity and moronity impact of substance abuse is indicated by the fact that more than half of all homicides, suicides, assaults, motor vehicle accidents, drownings, and fires are alcohol- or dn~g-related (West al., 1984)
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From page 47... ...
Improve Individual Patient Outcome In many cases, new imaging modalities have replaced He need for more invasive and risky diagnostic procedures. Better info~madon may detect disease in an earlier stage and subsequently decrease morbidity and mor~ity.
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From page 48... ...
R m E S Reduce Unit or Aggregate Cost Hospices devoted $2.2 billion of their total S8.3 billion for equipment spending to diagnostic imaging equipment (ECRI, 1989a)
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From page 49... ...
Assessments in me area of diagnostic laboratory testing would have the potential to do the following. Improve Individual Patient Outcome Many diagnostic laboratory tests have an invasive component that can cause discomfort and pose health nsks.
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Assessing the emerging technology of EPO would have the potential to do the following. Improve Individual Patient Outcome EPO is reported to be efficacious in treating the anemia of ESRD and its related symptoms: weakness, fatigue, and activity limitation (Eschbach et al., 1987~.
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Improve Individual Patient Outcome These devices can provide a wide range of patient benefits. They can help avert fatal cardiac evens; restore lost or absent heanng; improve touch, sensation, and muscle function; and prevent unwanted pregnancies.
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From page 52... ...
Reduce Unit or Aggregate Cost Intensive care is thought to be responsible for approximately 15 to 20 percent of hospital expenses. In 1982, it accounted for between $13 billion and S15 billion of costs associated with patients in adult ICUs and coronary care units (Office of Technology Assessment, 1984)
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From page 53... ...
Improve Individual Patient Outcome Successful organ transplantation can reverse a patient's previous chronic disease and significantly reduce Be associated mortality, morbidity, d~isability, and diminished quality of life.
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From page 54... ...
Auroras Social and Ethical Implications Because Mere are many more potential recipients than donor organs, ethical issues arise about how these limited resources can be allocated fairly. Advance Medical Knowledge Furler developments in t~plan~ion should continue to uncover information about nomad and abnormal immune function (e.g., rejection of Dansplanted organs)
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