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Evidence Based Medicine
Old 03-17-2014, 11:48 AM   #1
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Evidence Based Medicine

Posted here as a separate subject, although there have been indirect references to it in other threads... ie "10 tests to avoid".
The wiki reference is here:
Evidence-based practice - Wikipedia, the free encyclopedia
but there are numerous references thoughout Wiki and the Medical community
with terms such as "Evidence Based Medicine", Outcome Based Practices etc...

It may be important to all of us, monetarily, in the very near future, as medical costs spiral upward.

To begin, is to acknowledge and understand that there are vested interests that come into play, on two sides. One, is the total effect that medical costs has on the economy, and the "WHO" who pays for the products and services. On the other side, are those who benefit from these same products and services. Thus the political importance of the issue.

On the one hand, the point of the "Greater Good"... the overall effect on society as a whole, as in saving money for all... and the interest of others, who are directly affected.
An extreme example might be the costs of developing a medication (let's say $100 million) to the benefits to a small group of 20 persons that this medication might help, or even save their lives.

And so we come down to the basic issue: The acceptance and furtherance in medicine of those products and services that are cost efficient. That would eventually mean that costs would go down, because insurances of all kinds, private and government would eventually reduce payments for, or not pay at all... for medical pharmaceuticals or procedures that had an tiny chance of being successful... (a made up example)... a full hand transplant that cost $300K, but had only a 3% chance of success.

We experienced an example of this kind of selective payment system, when my wife experienced severe leg pain, from varicose veins. Prior to the operation (stripping the veins), the doctor performing the operation had to get clearance from Medicare for payment. Medicare rejected the request, and the question for approval had to be put before a board of doctors, who eventually recommended approval.

Since the subject is coming more to the fore, knowing something of the background of the Why's... may help to understand the coming news items and progress of "outcome based medicine".

As mentioned in the "tests to avoid" thread... the AARP/insurance connection, should not be overlooked as motivation for the article.
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Old 03-17-2014, 11:55 AM   #2
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the 'Evidence bases versus intuition' section could also add 'evidence based versus the internet' to it. for instance, evidence based process would support vaccinations, but look at the 'internet intuition' that is against vaccination. I've also seen internet sources that have all sorts of claims about lipids and heart care that appear to be less than evidence based.
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Old 03-17-2014, 12:26 PM   #3
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Here is a physician viewpoint of the changing landscape of medicine.

The quote is only a small part of a longer opinion...
Quote:
There is nothing “primary” about being a healthcare provider today. Gone are the days of the family physician being the respected authority and medical decision maker, as our parents and previous generations experienced. America has become a society driven by profit, allowing insurance companies to control the once respected family doctors ability to make “the best” choice for his patient, based on the individual history and risk factors.

Physicians’ medical practices are overwhelmed with the increased demands for quality, preventive healthcare and challenged with burdensome regulations for reimbursement by Medicare. Physicians have been forced to either hire additional staff to recuperate payment, or write off large amounts of treatment cost. Only a few short decades ago, insurance companies began to bargain with providers for “managed” care, hence the birth of HMO’s.

Soon private insurance carriers slowly and insidiously began to negotiate away the rights and choices of patients, and physicians struggled to be reimbursed for what once were accepted “standards of care” to treat and prevent complications.

What are the costs to quality, appropriate and timely healthcare to the upcoming baby boomers? Floridians are challenged with our unique disproportionate elder population and fewer medical doctor candidates choosing to become family or primary care providers.
Outcome Based Medicare Reimbursement? on Orlando Medical News

....and this:http://www.ispor.org/councils/decision_making.asp

A factual analysis of the proces of decision making... technical..., but in the overall, a listing of the government and private organizations involved in contempraneous decisions, indicate the importance and breadth of the subject as it affects each of us. Much more to come in the near future.
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Old 03-17-2014, 12:32 PM   #4
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Something like UK's National Institute for Health and Care Excellence

NICE's role is to improve outcomes for people using the NHS and other public health and social care services. We do this by:
  • Producing evidence-based guidance and advice for health, public health and social care practitioners.
  • Developing quality standards and performance metrics for those providing and commissioning health, public health and social care services;
  • Providing a range of information services for commissioners, practitioners and managers across the spectrum of health and social care.
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Old 03-17-2014, 12:45 PM   #5
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You might want to check out the Institute for Healthcare Improvement. IHI Home Page
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Old 03-17-2014, 12:49 PM   #6
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Quote:
Originally Posted by landover View Post
Something like UK's National Institute for Health and Care Excellence

NICE's role is to improve outcomes for people using the NHS and other public health and social care services. We do this by:
  • Producing evidence-based guidance and advice for health, public health and social care practitioners.
  • Developing quality standards and performance metrics for those providing and commissioning health, public health and social care services;
  • Providing a range of information services for commissioners, practitioners and managers across the spectrum of health and social care.
YES! An excellent site... This is a secondary page from the site. The link to AtoZ topics leads to a great information source on hundreds of different medical issues... with a good overviews of the problem, treatment prognosis and associated pertinent general knowledge, presented in an understandable manner.
Great website.

http://www.evidence.nhs.uk/topics

Note: if you go to the page for a specific health issue, note the side of the page, info about "uncertainty"... this is the kind of thing that evidence based medicine is exploring.
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