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Tuesday, October 07, 2008

A Must Read Article on Evidence Based Medicine.

I came upon the great article a few days ago.

Evidence of a Need for Change

How likely is it that you will receive treatment the medical literature says is best? Flip a coin. Evidence-based health care can improve those odds, save lives and cut health care costs dramatically.

High cost is the high-profile villain of American health care, and fall is the season when it sashays onto center stage. It is the time of year when employers and Medicare make annual announcements of the extra bite rising health insurance premiums will take out of next year’s paycheck or retirement income, and, this fall, it is also presidential election season. That means a spotlight on the urgent need to corral high medical costs as part of national health care reform.

Yet if the cost of insurance is an obvious concern, there is another fundamental problem in American medicine at least as disturbing in its implications for both wallet and well-being. That problem centers on what happens to patients once they are inside the doctor’s office or hospital.

One way to highlight what is at stake is with a number: 55 percent. That figure represents the chances you will receive the treatment the medical literature says is best for your illness. Put differently, it’s roughly the flip of a coin — heads, yes; tails, no. The odds for common individual conditions are hardly more encouraging. Hip fracture? Patients receive what is known as evidence-based care a dismal 23 percent of the time, according to a study in The New England Journal of Medicine. Breast cancer treatment? The disease’s high profile helped it finish at the top of the list by being evidence-based all of three-quarters of the time (76 percent).

An earlier comprehensive study of evidence-based care that used a slightly different methodology was only slightly more reassuring. While the average rate of evidence-based treatment was higher (60 percent for chronic care and 70 percent for acute care), the authors calculated that patients received “contraindicated” therapy (that’s medicalese for “Don’t do this!”) 20 percent of the time for chronic conditions and 30 percent of the time for acute ones.

If you are tempted to think, “Not my doctor,” think again. Providers in low-income areas perform more poorly on some quality measures, but the broader research shows socioeconomic status provides no sanctuary. The widespread failure to do the right thing for the right patient at the right time is egalitarian in its impact.

By comparison to health care, America’s airlines are paragons of reliable performance. In 2007, one of the worst years on record, the average airline on-time rate was about 74 percent, while the individual airline that was the worst of the bad had an on-time record of 65 percent. The rate of “contraindicated” flights (flying to the wrong city, for example) was negligible, and, perhaps most significantly, the safety record was vastly better.

Experts believe that a stunning 20 to 40 percent of the $2.4 trillion America spends on health care in 2008 will be wasted on misuse (including harmful and fatal errors), overuse (care that’s unnecessary) or underuse (effective care that’s not provided). If you take a midrange figure — let’s say 30 percent — you end up with $720 billion in savings. That’s enough in health care savings to pay the cumulative costs of the Iraq war (about $560 billion by mid-September 2008) and still have enough cash left over to pay for universal health care and the entire federal education budget. If you simply sent out a rebate check, it would come to some $2,100 for every man, woman and child in the country.

And that’s just one year of savings.

10 further pages and some great pictures here:

http://www.miller-mccune.com/article/691

This is a really excellent outline of the case for Evidence Based Medicine while identifying just how hard getting evidence based practice actually is and what the barriers are.

Health IT can help but human nature can be hard to shift!

David.

1 comment:

Andrew Weller said...

Great article David.
It is a pity that our Australian Health System seems to be spending money on massive data collection engines - be that Patient Administration Systems or Electronic Health Record Systems without finding ways to get clinical-context aware evidence-based guidance in front of clinicians when they need it.
There are big patient safety and financial business cases to be had from changing clinical behaviours... time to think small me thinks, and generate some returns from the money we keep sinking into big expensive infrastructure.