Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
Currently Skimming:
2 Promise and Limitations of Effectiveness and Outcomes Research
2 Promise and Limitations of Effectiveness and Outcomes Research
Pages 8-18
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From page 8... ...
Studies of the actual delivery of health care and "what works in the practice of medicine" are a legitimate and important priority for health scientists. We therefore applaud the imagination and efforts of William Roper, former Administrator of HCFA, Acting Administrator Louis Hays, and the HCFA staff for their leadership and energy in stimulating interest and focusing attention upon effectiveness research.
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From page 9... ...
Thus, the size and scope of the HCFA data files offer remarkable opportunities for effectiveness studies based on monitoring and surveillance of large populations. This data base allows us, with considerable accuracy and for specific diagnoses, to (a)
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From page 10... ...
The core committee recognized the clear need for an episode-of-care approach to analyzing the outcomes of care, which among other things calls for appreciable efforts to collect ambulatory and other out-of-hospital information, including posthospitalization outcomes data. Again, some examples may be useful.
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From page 11... ...
In-hospital mortality associated with initial treatment of both breast cancer and hip fracture is very low; only longitudinal studies can identify the effectiveness of a particular treatment combination. Finally, appropriate care for hip fracture requires that the earliest stages of rehabilitation occur during acute hospitalization but that rehabilitation be fully pursued in whatever settings are appropriate and available a rehabilitation hospital, skilled nursing facility, home health care, or family care.
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From page 12... ...
For those beneficiaries who seek care for an acute illness, this health status document could be updated at the onset of care for the acute episode and at periodic intervals thereafter; a different schedule might be devised for beneficiaries who seek care for chronic illness. In this way, the data from a generic health status instrument would contribute to risk stratification for this 5 percent cohort and would provide insight into the outcomes of efforts at prevention as well as management of acute illness.
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From page 13... ...
HCFA has recognized the importance of this concept; in fact, risk stratification provided crucial insights into HCFA's studies of coronary angioplasty versus coronary bypass surgery as a treatment for AMI. Developing a good health status instrument should greatly improve risk stratification and determination of disease stage.
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From page 14... ...
Use of the Predictive Instrument for Acute Ischemic Heart Disease, developed by Michael Pozen and Harry Selker, to determine an emergency room patient's true probability of having acute cardiac ischemia, including AMI and unstable angina (the group most physicians would consider appropriate for coronary care unit admission) , is one example of stratification in studies of AMI.
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From page 15... ...
The challenges offered by the need for data validation, longitudinal surveillance, risk stratification, health status assessment together with the need for pursuing a diverse but coordinated approach to effectiveness research led us to the following observations. RANGE OF STUDY DESIGNS The core committee believes that a diversity of approaches is needed in this program; proper effectiveness research and outcome studies will require research and demonstration projects, case-control studies, and the like to be conducted by a wide variety of investigators.
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From page 16... ...
Dissemination of information will be a considerable responsibility as the field of effectiveness research evolves. Several workshop participants congratulated HCFA on its willingness to provide investigators with access to HCFA data bases; such accessibility and cooperation are strongly encouraged and supported.
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From page 17... ...
It has laid the foundation for connecting clinical data on use with expenditure data on resource consumption; it has nurtured the development of assessments of functional and health status; it has promoted concern for outcomes research; and it has been responsible for numerous advances in measurement, methodology, and data base development. Effectiveness research adds another dimension to these activities, one that can be extremely valuable in guiding physicians, patients, the public,
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From page 18... ...
The core committee reflects all these perspectives in its emphasis on the need for access to data about drugs and procedures (and outpatient care in general) , information on risk stratification, the development of appropriate tools for measuring health status, and longitudinal studies of a cohort of Medicare beneficiaries.
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