Leadership Commitments to Improve Value in Health Care Finding Common Ground: Workshop Summary (2009) / Chapter Skim
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3 Transformational Opportunities
3 Transformational Opportunities
Pages 67-78
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From page 67... ...
For example, information gleaned as part of routine practice might be made more central to discovery, innovation, and research; the culture of health care might define new stakeholder roles and responsibilities to better support value in health care; and increased investment might produce comparative effective ness information to better inform decision making by patients and healthcare professionals about the risks and benefits of a particular treatment and the role of patient preference in determining courses of treatment. As part of the discussion of sectoral strategies, workshop participants were asked to specifically consider what initiatives and opportunities represented the most promising approaches to bringing about transformative change within health care.
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From page 68... ...
FOCUS ON THE VALUE PROPOSITION Workshop participants viewed an effort to drive clarity and consensus around the principles and elements of the value proposition common among all stakeholders as a first priority for multistakeholder collaboration. Because participants cited increased value as a desired outcome of sector activities, a focus on value offers an opportunity to align stakeholder interests around a common goal, a step considered potentially transformative in building a greater sense of trust and a willingness of the sectors to collaborate.
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From page 69... ...
Guiding principles on the application of available evidence are needed not only to help decision makers determine when they should apply a proposed diagnostic or treatment intervention, but also to guide other processes informed by some interpretation of the evidence, such as market approval, insurance coverage, provider use, and patient acceptance. Such clarity is needed because without mutual understanding among all parties involved of the bases on which the evidence will be interpreted and applied, the generation of new evidence may result in little or no benefit to patient care.
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From page 70... ...
NATIONAL PRIORITIES: CHALLENGES OF UNUSED AND UNAVAILABLE EVIDENCE Many issues confound the delivery of appropriate care to patients, but perhaps the most fundamental issue is the absence of information that could be used to guide treatment decisions. In most instances, the available information is insufficient or not appropriately organized to guide the selection of choices from among competing treatment options.
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From page 71... ...
Taking advantage of existing resources will require not only a prioritization of areas in need of evidence development but also efforts to address the limited adoption and diffusion of many practice interventions of demonstrated benefit. Recent analyses have demonstrated not only that care varies significantly for reasons unrelated to appropriateness, but that even when the available evidence strongly supports a regimen of care -- or best practice -- such care is received, on average, only half of the time.
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From page 72... ...
Collaboration between sectors to help develop national priorities would serve to engage stakeholders in a common agenda and inform strategic decisions about who is responsible for generating evidence, synthesizing it, paying for its collection and interpretation, and ultimately ensuring that the evidence is translated into practice. In a world of limited resources for research and development, participants emphasized that priority setting would help stakeholders best apply the existing resources.
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From page 73... ...
Health data are collected routinely for financial and administrative purposes and are increasingly collected during the course of care through electronic health records and other mechanisms. However, the available data are not systematically used to assess the results of treatments employed in routine practice.
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From page 74... ...
Better tools and processes for collection and analysis of the data required to generate evidence are needed. One way to expand the evidence base would be to find ways to improve the capture of data relevant to comparative effectiveness research and to informing clinical experience, in part by drawing more comprehensively on the expertise of researchers, healthcare delivery systems, and healthcare professionals as well as by making more effective use of information technologies.
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From page 75... ...
is working to develop standards and processes that can be used to optimize the retrieval and analysis of information from electronic healthcare databases. FDA has also put forth the concept of establishing a sentinel network for safety surveillance, which relies on a sophisticated ability to mine electronic databases, and created the Critical Path Initiative, which was designed to modernize the scientific process that transforms a potential human drug, biological product, or medical device from a discovery into a medical product.
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From page 76... ...
Having wide access to robust, fully functional electronic healthcare databases that can provide clinical decision support and link to research findings is seen as a critical goal. It was noted that stakeholder commitment is needed to provide the financial support to foster the wider application of evidence in clinical practice through the use of medical informatics.
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From page 77... ...
However, to have an impact on practice and health, several systems changes are also required. Specific needs include guidelines for the use of evidence-based medicine in healthcare settings, more investment by government and insurers in providing access to electronic health records and in utilizing medical informatics, enhanced guidelines to increase the use of evidence-based practice recommendations, strategies to motivate and support expertise in the use of these practices among healthcare professionals, and better practical training in such practices for students in the medical and healthcare professions, including practice competence for licensure and certification.
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From page 78... ...
To help ensure the centrality of the patient, sector participants suggested that providers develop skills that allow them to assess their patients' preferences and communicate better with them. Better communication will require providers to have tools, strategies, and even specific messages that will help improve provider-patient communications, particularly in ways that would keep those conversations focused on the evidence and inform physician and patient decisions with the available evidence.
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