The following press release came from the US Institute of Medicine (IOM) a few days ago.
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12038
IOM Recommends New National Program To Evaluate Effectiveness Of Health Care Products And Services And End Confusion About Which Work Best
WASHINGTON — Solutions to some of the nation's most pressing health problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. Spending on ineffective care contributes to rising health costs and insurance premiums. Variations in how health care providers treat the same conditions reflect uncertainty and disagreement about what the standards for clinical practice should be. Patients and insurers cannot always be confident that health professionals are delivering the most effective care.
A new report from the Institute of Medicine offers a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise, and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. This program would also be responsible for developing and promoting rigorous standards for clinical practice guidelines, which could help minimize the use of questionable services and target services to the patients most likely to benefit, said the committee that wrote the report.
"We need a way to synthesize data about the effectiveness of health care products and services in a standardized, objective fashion that will be considered reliable and trustworthy by all decision makers," said committee chair Barbara J. McNeil, Ridley Watts Professor and head, department of health care policy, Harvard School of Medicine, and professor of radiology, Brigham and Women's Hospital, Boston. "A system coordinated by a single, national entity that can prioritize and coordinate these evaluations would enable us to sort the wheat from the chaff and make sense of it all."
Although several organizations conduct evidence reviews and develop clinical practice guidelines, a single entity with the authority and resources is needed to determine what works and end confusion, the report says. Lack of coordination has led to duplication of effort, dozens — and in some cases hundreds — of competing practice guidelines, and uncertainty about which study results and guidelines are the most reliable and objective. This situation complicates the push to empower individuals to become more engaged in choosing and managing their care, the committee said.
If established in a way that ensures transparency, scientific rigor, and high standards for accountability and objectivity, the proposed national program would be a trusted resource for reliable information on the effectiveness of health services, the report says. With thousands of new clinical studies published every year, the amount of medical data has become so vast that it is essentially unmanageable for providers, patients, health plans, and others. Most people, including many health professionals, lack the scientific training necessary to evaluate and interpret such clinical findings by themselves. Moreover, research has shown that when evidence reviews are financed by manufacturers or vendors — as a significant proportion are — they are more likely to show effectiveness, which leads some to question whether, or to what extent, the cumulative body of evidence for any given health care product or service is biased.
The committee noted the relevance of cost and cost-effectiveness analysis to this issue, but did not make cost-related recommendations. Many policymakers believe cost-effectiveness information could guide more efficient use of health care resources, but the committee was asked to focus on other issues in its study. The report notes that reliable cost-effectiveness analysis depends on having high-quality evidence on the effectiveness of products and services.
The study was sponsored by the Robert Wood Johnson Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.
End Release.
Copies of Knowing What Works in Health Care: A Roadmap for the Nation are available for browsing or purchase from the National Academies Press.
There is a download summary available here.
This is a really important report and it has huge relevance for Australia. Just as in the US we have a legion of different entities all developing recommendations, guidelines and so on (think Cochrane Collaboration, Therapeutic Guidelines, The learned clinical Colleges, the TGA, the Pharmaceutical Benefits Advisory Council (PBAC), the various Departments of Health advisory committees, GP magazines and so it goes on) and the informed layman – as well as Government – have no real idea as to the quality and reliability of what is produced – let alone what hidden vested interests may be operating.
With a scope of diagnostic, treatment, and prevention services this is a huge job but it has to be worthwhile just so we can all know the answer to one key question – what really works and what doesn’t.
The secondary issue is, if it works is it sensibly affordable – and that is clearly a political and economic decision.
One could sensibly hope the scope could also be extending to Health IT to develop evidence in this domain as to what works and what doesn’t – but I fear that is a way off yet.
It does need to be noted that an idea like this is not new.
The UK National Institute for Health and Clinical Excellence certainly has a very similar mandate, and while occasionally causing controversy for making some hard decisions is clearly a success.
The role is succinctly put:
Who we are
The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.
What we do
NICE produces guidance in three areas of health:
- public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
- health technologies - guidance on the use of new and existing medicines, treatments and procedures within the NHS
- clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.
Time for Australia to follow our two “Great and Powerful Friends” I believe!
David.
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