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FOR IMMEDIATE RELEASE
IOM RECOMMENDS NEW NATIONAL PROGRAM TO EVALUATE EFFECTIVENESS OF HEALTH CARE PRODUCTS AND SERVICES AND END CONFUSION ABOUT WHICH WORK BEST
WASHINGTON — Solutions to some of the nation's most pressing health problems hinge on the ability to identify which diagnostic, treatment, and prevention services work best for various patients and circumstances. Spending on ineffective care contributes to rising health costs and insurance premiums. 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.
A new report from the Institute of Medicine offers a blueprint for a national program to assess the effectiveness of clinical services and to provide credible, unbiased information about what really works in health care. The report recommends that Congress direct the U.S. Department of Health and Human Services to establish a program with the authority, expertise, and resources necessary to set priorities for evaluating clinical services and to conduct systematic reviews of the evidence. This program would also 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.
"We need 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," said committee chair 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. "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."
Although several organizations conduct evidence reviews and develop clinical practice guidelines, a single entity with the authority and resources is needed to determine what works and end confusion, the report says. Lack of coordination has led to duplication of effort, dozens — and in some cases hundreds — of competing practice guidelines, and uncertainty about which study results and guidelines are the most reliable and objective. This situation complicates the push to empower individuals to become more engaged in choosing and managing their care, the committee said.
If established in a way that ensures transparency, scientific rigor, and high standards for accountability and objectivity, the proposed national program would be a trusted resource for reliable information on the effectiveness of health services, the report says. With thousands of new clinical studies published every year, the amount of medical data has become so vast that it is essentially unmanageable for providers, patients, health plans, and others. Most people, including many health professionals, lack the scientific training necessary to evaluate and interpret such clinical findings by themselves. Moreover, research has shown that when evidence reviews are financed by manufacturers or vendors — as a significant proportion are — they are more likely to show effectiveness, which leads some to question whether, or to what extent, the cumulative body of evidence for any given health care product or service is biased.
The committee noted the relevance of cost and cost-effectiveness analysis to this issue, but did not make cost-related recommendations. Many policymakers believe cost-effectiveness information could guide more efficient use of health care resources, but the committee was asked to focus on other issues in its study. The report notes that reliable cost-effectiveness analysis depends on having high-quality evidence on the effectiveness of products and services.
The study was sponsored by the Robert Wood Johnson Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. A committee roster follows.
Copies of Knowing What Works in Health Care: A Roadmap for the Nation are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
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[ This news release and report are available at http://national-academies.org ]
INSTITUTE OF MEDICINE
Board on Health Care Services
Committee on Reviewing Evidence to Identify Highly Effective Clinical Services
Barbara J. McNeil, M.D., Ph.D. (chair)
Ridley Watts Professor and Head
Department of Health Care Policy
Harvard Medical School; and
Professor of Radiology
Harvard Medical School
Brigham and Women's Hospital
Harold C. Sox, M.D., M.A.C.P. (vice chair)
Annals of Internal Medicine
American College of Physicians
Allen Daniels, LISW, Ed.D.
Chief Executive Officer
Alliance Behavioral Care; and
Professor of Clinical Psychiatry
University of Cincinnati
Kay Dickersin, M.A., Ph.D.
Professor of Epidemiology, and
Center for Clinical Trials
Bloomberg School of Public Health
Johns Hopkins University
Robert S. Galvin, M.D.
Director of Global Health Care
General Electric Co.
Dana P. Goldman, Ph.D.
Chair and Director of Health Economics, Finance, and Organization
Santa Monica, Calif.
Richard A. Justman, M.D.
National Medical Director
United Healthcare Corp.
Arthur A. Levin, M.P.H.
Center for Medical Consumers
New York City
Richard E. Marshall, M.D.
Medical Director for Research, and
Harvard Vanguard Medical Associates
Wilhelmine Miller, M.S., Ph.D.
Associate Research Professor
School of Public Health and Health Services
George Washington University
Sally C. Morton, Ph.D.
Vice President for Statistics and Epidemiology
Research Triangle Institute
Research Triangle Park, N.C.
Samuel R. Nussbaum, M.D.
Executive Vice President, and
Chief Medical Officer
Diana B. Petitti, M.D., M.P.H.
Department of Preventive Medicine
Keck School of Medicine
University of Southern California
Steven Shak, M.D.
Chief Medical Officer
Genomic Health Inc.
Redwood City, Calif.
Lisa Simpson, M.B., B.Ch., M.P.H., F.A.A.P.
Child Policy Research Center
Cincinnati Children's Hospital Medical Center; and
Department of Pediatrics
University of Cincinnati
Glenn D. Steele Jr., M.D., Ph.D.
President and Chief Executive Officer
Geisinger Health System
INSTITUTE OF MEDICINE STAFF
Jill S. Eden, M.B.A., M.P.H.