Leadership Commitments to Improve Value in Health Care Finding Common Ground: Workshop Summary (2009) / Chapter Skim
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Pages 97-116
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Since 2000, health insurance costs have increased by 87 percent (Kaiser Family Foundation/Health Research and Educational Trust, 2006)
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Exacerbating the problems of escalating costs and quality gaps is the dearth of reliable evidence to inform clinician and patient decisions. A substantial portion of the medical care delivered in the United States is not based on or supported by evidence, although experts differ on the degree to which this is the case (Learning What Works Best, 2007)
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Findings from studies assessing decision support programs suggest that patients who use these tools achieve increased knowledge, have more realistic expectations about the benefits and harms of the treatment options, and feel less uncertainty about feeling uninformed (O'Connor et al., 2003)
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Evidence-based content to help consumers understand healthcare quality needs to be supported by communication strategies that promote clear, understandable messages directed to target audiences through appropriate channels (Robert Wood Johnson Foundation-Aligning Forces for Quality, 2007)
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Others, such as AARP, bring the strength of numbers as well as a politically active cadre of volunteers to influence federal and state legislative and regulatory bodies. The National Breast Cancer Coalition establishes public policy and legislative priorities in research and access to health care and mobilizes its nationwide grass roots to enact its agenda and also trains and educates its members to promote systems change to achieve its mission of ending breast cancer.
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Association Broad, crosscutting/ Consumers United for Evidence-Based Healthcare, National consensus building Health Council NOTE: Many organizations represent consumers from multiple perspectives. example, the Alliance for Better Health Care, is a coalition of consumers, employers, unions, providers, health plans, pharmacists, and researchers who share the conviction that high-quality health care requires good evidence to support sound medical decision making (Alliance for Better Health Care, 2007)
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For example, Consumers United for Evidence-Based Healthcare has developed online modules to provide consumer advocates with critical appraisal skills. The National Breast Cancer Coalition (NBCC)
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It is generally understood that it is most efficient and effective to take advantage of the multiple opportunities to influence consumer decision making at the time of greatest impact -- the "teachable moment." These moments typically occur when people are contemplating the choice of health plans, health professional, hospital, skilled nursing facilities, and so forth; at the time of a diagnosis when the selection of a treatment option is required; when self-management techniques are presented; when a patient is considering whether or not to participate in a clinical trial; and as patients contemplate healthy lifestyle changes, such as changes to their diet or to their exercise and physical activity patterns, smoking cessation, and substance abuse prevention and treatment. For pregnant women, the 9-month prenatal period offers a window of opportunity to provide them with information based on the best available evidence to help them make informed decisions about maternity and newborn care.
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There are many good examples of effective dissemination approaches that adapt conventional educational vehicles to advance evidence-based frameworks. For example, Childbirth Connection makes relevant evidencebased resources accessible to health professionals by specialty area in the health professional area of its website, where it maintains an EvidenceBased Maternity Care Resource Directory; Childbirth Connection also has, since 2003, contributed a quarterly column, Current Resources for Evidence-Based Practice, that is published simultaneously in the official journals of the leading U.S.
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Finally, education initiatives should not overlook opportunities to train clinicians to communicate more effectively with patients, enhance clinician awareness of the wide range of health literacy and decision-making skills among consumers, as well as train clinicians on the need to respond appropriately to consumer cultural and language preferences. Ultimately, medical education and training need to be revamped to become more patient focused, to incorporate courses on patient communication to teach physicians how to foster patient autonomy and self-management, and to encourage patient engagement in decision making.
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. Although the proportion of consumers who use information about healthcare quality for decision making is growing, in 2006, only about 20 percent reported that they had seen information about health insurance plans, hospitals, or doctors and then factored such information into a decision (Kaiser Family Foundation/Agency for Healthcare Research and Quality, 2006)
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. Therefore, in developing communication strategies, the research findings that describe how consumers use information must be built on and the decision-making skills of target audiences must also be considered by employing methods that lower the cognitive effort required to make decisions.
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. The capacity to navigate successfully in the healthcare system requires patients to have adequate health literacy skills.
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. Underscoring the value that they place in participating in HIT policy development, consumer organizations have set forth a set of principles to guide electronic information sharing that address transparency, access to and the use of personal health information, individual control, data security, and the enforcement of privacy protections (Detmer and Steen, 2006)
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LEADERSHIP COMMITMENTS AND INITIATIVES Transformational Opportunities Through Collaboration Because multiple factors deter informed decision making, these obstacles must be removed to achieve reform. Most consumers do not have access to "good" information on treatment options or provider performance on which to base their healthcare decisions and rarely have enough information to make informed decisions (Demchak, 2007a)
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First, to achieve the Roundtable's objective of transforming the way in which evidence on clinical effectiveness is generated and used to improve health and health care, consumer organizations will have to join with other stakeholders to advocate for the establishment of an independent, publicprivate entity tasked with coordinating comparative effectiveness research whose analyses are objective and fully transparent. This will involve achieving consensus on the structure and purpose of such an entity.
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Several recent communication initiatives may inform the development of the core messages, including the AHRQ and Ad Council campaign Questions Are the Answer, and several efforts by health plans (Aetna) , the Joint Commission (Speak Up)
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to • determine the comparative effectiveness of all types of treatment and pharmaceutical interventions under different circumstances; greater transparency and the availability of comparative perfor • mance information across all settings and collaboration with providers, plans, and employers to develop quality and efficiency measurement for public reporting; improved means of capturing clinical data to accelerate evidence • development, particularly on late effects and the effect on the general population after the initial demonstration of efficacy in controlled clinical trials; and the more widespread adoption of HIT that ensures secure data • sharing while protecting patient privacy. In addition, there are opportunities for consumers-employees to work with employers and purchasers to reach a consensus on the mutually acceptable use of EBM in benefit design, benefit tiering, and cost sharing and to collaborate with researchers on the design and testing of decision support tools to ensure that they meet consumer needs.
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Washington, DC: The National Academies Press. Kaiser Family Foundation/Agency for Healthcare Research and Quality/Harvard School of Public Health.
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2005. Attitudes of Americans regarding personal health records and nationwide electronic health information exchange: Key findings from two surveys of Americans.
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