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Using Evidence

Making Decisions

Presenter:

Carolyn M. Clancy, M.D., Director, Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD.


This session explored the utility of evidence in healthcare policymaking. According to Dr. Clancy, the use of evidence by healthcare policymakers is an important input to healthcare decisions. Evidence can help reduce uncertainty in medical decisions ranging from public policy decisions (whether a certain treatment should be covered) to clinical policy decisions (which individual patients should receive a covered treatment).

Evidence-based decisionmaking is the use of evidence in healthcare decisions and includes:

  • Evidence-based medicine: The use of current best evidence in making decisions about the care of individual patients.
  • Evidence-based healthcare: The use of evidence by those managing health services to determine the mix of services and procedures that will give the greatest benefit to the population served.

Dr. Clancy explained that the use of evidence in healthcare decisionmaking is important because of the wide variation in clinical practices across different regions and among different segments of the population. Variations in clinical practice result in increased use of healthcare resources as well as underutilization of effective technologies. Often, both underutilization of effective treatments and over- and mis-utilization of other treatments co-exist in hospitals, ambulatory settings, and across communities. The application of evidence-based decisionmaking by health policymakers can help reduce these inconsistencies and improve the overall quality of care delivered to a patient population.

The many tools of evidence-based healthcare include:

  • Outcomes research.
  • Clinical practice guidelines.
  • Disease management.
  • Technology assessment.

The application of these "tools" supports the use and dissemination of medical evidence. Evidence-based healthcare can benefit those throughout the healthcare system by:

  • Informing patients.
  • Providing clinicians with information about the most effective therapies.
  • Allowing payers to make coverage decisions that will provide the best value to their covered population.
  • Helping regulators establish more consistent guidelines for the quality of medical care.

Given the proliferation of healthcare technology and medical evidence, greater demand for health services because of factors such as the aging of the population, and the existence of common misconceptions about effective medical treatment, evidence-based healthcare is an important part of decisionmaking in today's healthcare environment.

References

Outcomes and Effectiveness Research: The First Decade and Beyond. Rockville (MD): U.S. Department of Health and Human Services, Agency for Health Care Policy and Research. 1999 Jun. AHCPR Publication No. 99-R075.

Outcomes Research. AHRQ Fact Sheet. Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 Mar. AHRQ Publication No. 00-P011.

AHRQ Research on Diabetes Care. AHRQ Translating Research Into Practice. Rockville, (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 Jan. AHRQ Publication No. 00-P018.

AHRQ Research on Caring for Children with Asthma. AHRQ Translating Research Into Practice. Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 Feb. AHRQ Publication No. 00-P025.

Improving Quality of Care for People with Depression. AHRQ Translating Research Into Practice: Rockville (MD): U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. 2000 Jan. AHRQ Pub. No. 00-P020.

Clancy CM, Eisenberg JM. Outcomes research: measuring the end results of health care. Science 1998 Oct 9;282(5387):245-6.


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