Are consumers at the bottom of the evidence pyramid?

March 9, 2010 · Filed Under maternity, research issues · 8 Comments

We’re pleased to present another guest post by Amy Romano, which first appeared on the phenomenal maternity blog Science and Sensibility. See also her newest post, last night, here – including a terrific BlogTalkRadio interview in which she expresses herself on the virtues of Participatory Medicine.

I have argued (here and here on e-patients.net, and here on Reproductive Health Reality Check) that strategies that involve increased participation by women and families in maternity care hold major potential for improving our rather dismal maternal and infant health outcomes.

A study reported in the February issue of The International Journal of Gynecology & Obstetrics highlights a major obstacle to implementing consumer-led health strategies: lack of comparative effectiveness research supporting their use.

Tags: Academic Medical Institutions, Amy Romano, Child Health Research, Comparative Effectiveness, Consumer Involvement, Consumer Participation, Effectiveness Research, Evidence Pyramid, Family Centered Health Care, Health Care System, Health Outcomes, Health Strategies, Health Systems, Infant Health, Low Income Countries, Maternal And Child Health, Maternity Care, Newborns, Pregnancy And Childbirth, Pregnancy Childbirth, Reproductive Health, Systematic Reviews

Meaningful Use: The Elephant IS In The Room

May 18, 2009 · Filed Under general, medical records, policy issues, reforming hc, trends & principles · 18 Comments

Comparative Effectiveness: a comparison of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such studies may compare similar treatments, such as competing drugs, or they may analyze very different approaches, such as surgery and drug therapy. The analysis may focus only on the relative medical benefits and risks of each option, or it may go on to weigh both the costs and the benefits of those options.

I am afraid that by focusing so much on HITECH and on the definition of Meaningful Use and Certification on this blog we have been missing on the most important part of the “ARRA” stimulus package , the initial $1.1 bn. funding of Comparative Effectiveness Research (CER) to be spent by Sep. 2010. Specifically some of the $400 millions to be used at the discretion of the DHHS Secretary that must be allocated to encourage the development and use of clinical registries, clinical data networks, and other forms of electronic health data that can be used to generate or obtain outcomes data. It certainly looks like the national implementation of EHRs may become fully intertwined with CER.

The minimum definition of “Meaningful Use” as defined in ARRA includes e-prescribing, electronic exchange of medical information and interoperability. These are also the necessary elements to start implementing a national CER strategy. There is just too much at stake this time to think it won’t happen.

e-Patients should become informed about the potential impact of CER for future care. Please read the summary of the “Listening Session of the Federal Coordinating Council for Comparative Effectiveness Research” from April 14, 2009 to get a better understanding why we, the patients & patient groups, must get directly involved in helping to develop the CER private/public infrastructure & activities.

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