Conclusion

2020 ◽  
pp. 161-180
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
State Building ◽  
Evidence Based ◽  
Governance Reform ◽  
Patient Centered ◽  
Policy Makers ◽  
Long Run ◽  
Key Stakeholders ◽  
Political Sustainability ◽  
Reform Project ◽  
Based Medicine

This chapter focuses on the evidence-based medicine (EBM) reform project. Ultimately, if the EBM project is to realize its aspirational goal to improve the quality and efficiency of U.S. medical care, it is necessary but insufficient for research agencies like Patient-Centered Outcomes Research Institute (PCORI) to endure. In the long run, patterns of medical governance must change. PCORI (or whatever entity succeeds it) must develop a reputation among key stakeholders for competence, relevance, and impact that causes policy makers to conclude that supporting EBM is in their own political interest. The chapter then draws on lessons from the literature on U.S. state building to develop strategies to increase the durability of medical governance reform in contemporary American politics. It also briefly reviews the challenges of political sustainability that face any new agency or policy.

scholarly journals Psychiatry in the future

2004 ◽  
Vol 28 (8) ◽  
pp. 277-278
Author(s):  
Frank Holloway
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Evidence Based Medicine ◽  
Cochrane Collaboration ◽  
Routine Clinical Practice ◽  
Evidence Based ◽  
Policy Makers ◽  
The Future ◽  
The Cochrane Collaboration ◽  
Based Medicine

In an era of evidence-based medicine, policy-makers and researchers are preoccupied by the task of ensuring that advances in research are implemented in routine clinical practice. This preoccupation has spawned a small but growing research industry of its own, with the development of resources such as the Cochrane Collaboration database and journals such as Evidence-Based Mental Health. In this paper, I adopt a philosophically quite unfashionable methodology – introspection – to address the question: how has research affected my practice?

scholarly journals Varieties of Uncertainty in Health Care

2011 ◽  
Vol 31 (6) ◽  
pp. 828-838 ◽  
Author(s):  
Paul K. J. Han ◽  
William M. P. Klein ◽  
Neeraj K. Arora
Keyword(s):  
Health Care ◽  
Empirical Literature ◽  
Evidence Based ◽  
Shared Decision ◽  
Services Research ◽  
Patient Centered ◽  
3 Dimensional ◽  
Centered Care ◽  
Multiple Meanings ◽  
Based Medicine

Uncertainty is a pervasive and important problem that has attracted increasing attention in health care, given the growing emphasis on evidence-based medicine, shared decision making, and patient-centered care. However, our understanding of this problem is limited, in part because of the absence of a unified, coherent concept of uncertainty. There are multiple meanings and varieties of uncertainty in health care that are not often distinguished or acknowledged although each may have unique effects or warrant different courses of action. The literature on uncertainty in health care is thus fragmented, and existing insights have been incompletely translated to clinical practice. This article addresses this problem by synthesizing diverse theoretical and empirical literature from the fields of communication, decision science, engineering, health services research, and psychology and developing a new integrative conceptual taxonomy of uncertainty. A 3-dimensional taxonomy is proposed that characterizes uncertainty in health care according to its fundamental sources, issues, and locus. It is shown how this new taxonomy facilitates an organized approach to the problem of uncertainty in health care by clarifying its nature and prognosis and suggesting appropriate strategies for its analysis and management.

scholarly journals Don't know, can't know: embracing deeper uncertainties when analysing risks

2011 ◽  
Vol 369 (1956) ◽  
pp. 4730-4750 ◽  
Author(s):  
David J. Spiegelhalter ◽  
Hauke Riesch
Keyword(s):  
Level Structure ◽  
Evidence Based ◽  
Formal Models ◽  
Intergovernmental Panel ◽  
Policy Makers ◽  
Risk Modelling ◽  
Based Medicine ◽  
Expression Of Uncertainty ◽  
Modelling Process

Numerous types of uncertainty arise when using formal models in the analysis of risks. Uncertainty is best seen as a relation, allowing a clear separation of the object, source and ‘owner’ of the uncertainty, and we argue that all expressions of uncertainty are constructed from judgements based on possibly inadequate assumptions, and are therefore contingent. We consider a five-level structure for assessing and communicating uncertainties, distinguishing three within-model levels—event, parameter and model uncertainty—and two extra-model levels concerning acknowledged and unknown inadequacies in the modelling process, including possible disagreements about the framing of the problem. We consider the forms of expression of uncertainty within the five levels, providing numerous examples of the way in which inadequacies in understanding are handled, and examining criticisms of the attempts taken by the Intergovernmental Panel on Climate Change to separate the likelihood of events from the confidence in the science. Expressing our confidence in the adequacy of the modelling process requires an assessment of the quality of the underlying evidence, and we draw on a scale that is widely used within evidence-based medicine. We conclude that the contingent nature of risk-modelling needs to be explicitly acknowledged in advice given to policy-makers, and that unconditional expressions of uncertainty remain an aspiration.

Comparatively Ineffective? PCORI and the Uphill Battle to Make Evidence Count in US Medicine

2020 ◽  
Vol 45 (5) ◽  
pp. 787-800
Author(s):  
Eric M. Patashnik
Keyword(s):  
Health Care ◽  
Affordable Care Act ◽  
Treatment Options ◽  
Cultural Barriers ◽  
Health Care Spending ◽  
Evidence Based ◽  
Medical Evidence ◽  
Patient Centered ◽  
The Us ◽  
Based Medicine

Abstract The Patient-Centered Outcomes Research Institute (PCORI) was established as part of the Affordable Care Act to promote research on the comparative effectiveness of treatment options. Advocates hoped this information would help reduce wasteful spending by identifying low-value treatments, but many conservatives and industry groups feared PCORI would ration care and threaten physicians' autonomy. PCORI faced three challenges during its first decade of operation: overcoming the controversy of its birth and escaping early termination, shaping medical practice, and building a public reputation for relevance. While PCORI has won reauthorization, it has not yet had a major impact on the decisions of clinicians or payers. PCORI's modest footprint reflects not only the challenges of getting a new organization off the ground but also the larger political, financial, and cultural barriers to the uptake of medical evidence in the US health care system. The growing attention among policymakers and researchers to provider prices (rather than utilization) as the driver of health care spending could be helpful to the political prospects of the evidence-based medicine project by making it appear to be less as rationing driven by costs and more as an effort to improve quality and uphold medical professionalism.

scholarly journals Health technology assessment in Finland

2009 ◽  
Vol 25 (S1) ◽  
pp. 102-107 ◽  
Author(s):  
Marjukka Mäkelä ◽  
Risto P. Roine
Keyword(s):  
Decision Making ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Evidence Based ◽  
Policy Makers ◽  
Health Technologies ◽  
Based Medicine ◽  
Special Responsibility ◽  
Made In

Since the 1990s, health policy makers in Finland have been supportive of evidence-based medicine and approaches to implement its results. The Finnish Office for Health Technology Assessment (Finohta) has grown from a small start in 1995 to a medium-sized health technology assessment (HTA) agency, with special responsibility in providing assessments to underpin national policies in screening. External evaluations enhanced the rapid growth. In the Finnish environment, decision making on health technologies is extremely decentralized, so Finohta has developed some practical tools for implementing HTA findings. The Managed Uptake of Medical Methods program links the hospital districts to agree on introduction of technologies. The Ohtanen database provides Finnish-language summaries of major assessments made in other countries.

scholarly journals Medical Concepts with Clinical-Epidemiological Implications that have to be Re-Assessed Since the Coronavirus Disease 2019 (Covid-19) Pandemic

2020 ◽  
Vol 1 (1) ◽  
pp. 17-27
Author(s):  
Jose Luis Turabian
Keyword(s):  
Medical Model ◽  
Big Bang ◽  
Health Centers ◽  
Evidence Based ◽  
Patient Centered ◽  
Centered Care ◽  
Health Model ◽  
Based Medicine ◽  
The Big Bang ◽  
Medical Concepts

The coronavirus disease 2019 (COVID-19) pandemic is something new that baffles us. The dominant health model and the theory that supported it until before COVID-19 are refuted or invalidated by observing the current tragically situation, which also implies lasting changes in that new medical model. Consequently, once the urgency of the epidemic is over, the conceptual and organizational building of medical care can no longer be rebuilt in the same way. Based on the COVID-19 experience, it is necessary to rethink what kind of knowledge can emerge. Some of the concepts with clinical-epidemiological implications that have to be re-evaluated since the COVID-19 pandemic are: 1. Large epidemics or changes do not arise from an event similar to the "Big Bang", but rather they develop slowly and underground, so a surveillance system must be instituted; 2. Re-evaluate what we understand by "evidence-based medicine"; 3. Patient-centered care is inadequate and must be replaced by community-centered care; 4. Telecare and changes in the organization of consultations; 5. Hospitals and health centers are "biological bombs" that act as vectors of disease and must change their architecture, organization and use; 6. The end of the nursing home model; 7. Change of habits; and 8. Social media can democratize information and help communities organize.

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