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Evidence and the next stage of health care reform: Why consumer engagement is so important

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Evidence and the next stage of health care reform: Why consumer engagement is so important Steven D. Pearson, MD, MSc President, Institute for Clinical and Economic ... – PowerPoint PPT presentation

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Title: Evidence and the next stage of health care reform: Why consumer engagement is so important


1
Evidence and the next stageof health care
reformWhy consumer engagement is so important
  • Steven D. Pearson, MD, MScPresident, Institute
    for Clinical and Economic Review

2
What do we mean by evidence?
  • Evidence can have a bad aura among consumers
    and consumer advocates
  • Population-based instead of about the individual
  • Applied by insurers in ways that restrict access
    to tests and treatments desired by patients
  • Evidence-based medicine is the conscientious,
    explicit and judicious use of current best
    evidence in making decisions about the care of
    individual patients.
  • Sackett, 1996

3
Why better evidence became part of health care
reform
  • Much of what doctors do is not based on good
    evidence
  • Does FDA approval mean there is good evidence?
  • Lack of good evidence commonly leads to
    inappropriate and often unnecessary treatment
  • Autologous bone marrow transplant for metastatic
    breast cancer
  • Generic drugs for rheumatoid arthritis found to
    be as good as more expensive and risky new drugs
  • Tens of thousands of women each year might be
    able to skip at least some of the grueling
    treatments for breast cancer which can include
    surgery, heavy chemo and radiation without
    greatly harming their odds of survival.
  • Choosing Wisely will be discussed by Dr. Santa

4
Evidence-based medicine and health care reform
  • Comparative effectiveness research (CER)
  • Research comparing alternative care options to
    determine what works best for whom, under
    real-world conditions
  • Systematic review of existing published evidence
  • Generation of new evidence through clinical
    trials but also clinical registries and existing
    database analyses
  • Patient-centered outcomes research (PCOR)
  • PCORI
  • Health care reform did not focus on the evidence
    comparing doctors and hospitals

5
Why consumer engagement can be so powerful
  • Helping to identify research topics
  • PCORI
  • Things over which patients have control, e.g.
    diet, exercise
  • Helping to identify outcomes that are more
    patient-centered
  • Medications for pediatric seizures
  • Helping to interpret and guide the application of
    results
  • Examples from CEPAC and CTAF

6
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7
CEPAC and CTAF
  • Collaboration among
  • Patient groups
  • Connecticut Center for Patient Safety
  • Maine Quality Counts
  • Center for Healthcare Decisions
  • Patient Advocates in Research
  • State Medicaid programs
  • Private plans
  • Large physician-hospital groups
  • Independent Council meets in public to discuss
    tailored evidence reviews on effectiveness and
    cost, to vote on evidence, and to make
    recommendations for best practice and policy
  • All stakeholders work together afterward to
    implement the findings

8
New England CEPAC Topics and Impact
  • Treatments for Attention-Deficit Hyperactivity
    Disorder (ADHD)
  • Helped interpret evidence and disseminate to
    patient networks in order to shift to behavioral
    therapy for youngest children
  • Treatment for severe depression
  • Perspectives on severity of condition and impact
    on families part of deliberation that led to
    first-in-nation coverage for new magnetic
    treatment
  • Supplemental screening options for women with
    dense breast tissue

9
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10
Supplemental screening for women with dense
breast tissue
  • Consumer engagement critical in
  • Perspective on importance of the concern for
    masking as opposed to breast cancer risk
  • Judgments of the relative balance of benefits of
    identifying additional cancers and the harms of
    false positive results, biopsies, and anxiety
  • Determination of the information patients want
    and how to present it to women (see handout)
  • Dissemination of the report and materials to
    patient groups throughout California, New
    England, and nationally

11
Conclusion
  • Evidence, its generation, interpretation, and
    application to improve patient outcomes and the
    patient experience, is an important component of
    the next phase of health care reform.
  • Consumers have a critical role to play in
    advancing the best aspects of evidence-based
    medicine in the interests of patients now and in
    the future.
  • There is a shift occurring among clinicians and
    researchers that offers a new opportunity for
    engagement. Seize it!

12
Thank you
  • Steve Pearsonspearson_at_icer-review.org
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