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Volume 13 Number 16
ISSN 1091-4021
Friday, January 25, 2008

News: Quality

The Institute of Medicine on Jan. 24 issued a 280-page report recommending the creation of a national program to assess the effectiveness of clinical services and to provide unbiased information about "what really works in health care."

IOM said that solving some of the most pressing health problems depended on the ability to identify which diagnostic, treatment, and prevention services worked best for various patients and circumstances.

"Spending on ineffective care contributes to rising health costs and insurance premiums," IOM said. "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."

Recommendation That HHS Set Up Program

The report recommends that Congress direct the Department of Health and Human Services establish a program with the resources "necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence." This program also would 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.

IOM is part of the National Academy of Sciences, and was established in 1970 to provide "independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public." Its reports, notably one in 1999 drawing attention to the major consequences for patients of medical errors (No. 230 HCDR, 12/1/99 BNA's Health Care Daily Report ), have been very influential in shaping health care policies.

The committee responsible for the report was chaired by 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. In a statement accompanying the report, she called for "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." 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," she said.

Problems Highlighted

Among present problems highlighted in the report are:

• the fact that a significant proportion of health care costs are spent on "care that has not been shown to be effective and may actually be harmful";
• geographic variations in health care, which "often reflect deviations from accepted care standards or uncertainty and disagreement regarding what those standards should be";
• a need to improve quality, based upon improved scientific knowledge;
• a "dearth" of information that would enable consumers to make their own choices in the health care field; and
• problems faced by private and public health plans in assessing the benefits and potential drawbacks of newly available health services.

The program recommended by IOM would set priorities for, and fund and manage, reviews of clinical effectiveness; develop "a common language and standards for conducting systematic reviews of the evidence and for generating clinical guidelines and recommendations"; provide a forum to resolve conflicts in guidelines and recommendation; and prepare an annual report to Congress.

The era of the physician as "sole health care decision maker is long past," the report says. "In today's world, health care decisions are made by multiple people, individually or in collaboration in multiple contexts for multiple purposes. The decision maker is likely to be the consumer choosing among health plans, patients or patients' caregivers making treatment choices, payers or employers making guidelines or clinical recommendations, regulatory agencies assessing new drugs or devices, or public programs developing population-based health interventions. Every decision maker needs credible, unbiased, and understandable evidence on the effectiveness of health interventions and services."

Full text of the report is available.