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Report Offers Roadmap for Evidence-Based Medicine Center

By Mary Agnes Carey, CQ HealthBeat Associate Editor

February 25, 2008 -- A trustworthy system of comparative effectiveness research must be based on integrity, independence, and transparency, and serve as an honest broker in qualifying evidence-based medicine, according to a new report prepared for the Medicare Payment Advisory Commission (MedPAC).

Comparative effectiveness research compares treatment outcomes from different therapies for the same condition, allowing providers and patients to avoid ineffective or wasteful treatments.

A national center for evidence-based medicine should be independent and systematically identify evidence-based practices, conduct rigorous independent reviews of evidence-based research using strict protocols, and disseminate objective information, according to the report, prepared by staff of the American Institutes for Research. A comprehensive center would be built upon the work of several existing groups, such as the Agency for Healthcare Research and Quality's evidence-based practice centers, or the Oregon Health and Science University's Medicaid Evidence Based Decision Project, which provides state Medicaid programs with clinical evidence to assist in coverage decisions.

The study was prepared by Marilyn Moon, Benjamin Smith, and Sigrid Gustafson.

MedPAC's June 2007 report called for the establishment of an independent entity that would sponsor research on comparative effectiveness of health care services, and Senate Finance Committee Chairman Max Baucus, D-Mont., and House Ways and Means Health Subcommittee Chairman Pete Stark, D-Calif., hope to advance legislation to expand funding for research on the comparative effectiveness of health treatments and other initiatives.

Other countries, such as the United Kingdom, Australia, and Canada, are further along than the United States in the application of evidence-based information for decision making, the report notes. But some states, private managed care organizations and the Veterans Administration have all used some form of evidence-based decision making for establishing Medicaid prescription drug formularies. While Medicare also makes decisions about adoption of new techniques based on evidence of effectiveness, "what has been lacking is any universal effort to apply evidence more broadly, moving beyond effectiveness studies to identifying best practices and/or avoiding wasteful spending," the report states.

Information developed from comparative effectiveness reviews and the dissemination of that information "must be of the highest quality, developed with guidance of key stakeholders and consumers, able to withstand vigorous scrutiny, and able to reach multiple audience of varying levels of sophistication, in culturally appropriate and consumer friendly ways," the report states. Examples of comparative information in the report include medical intervention protocols, procedure fact sheets, Web-based guidelines, and expected clinical outcomes.

"The challenge is to accurately convey the results in plain language and be viewed by stakeholders as valuable sources of information," notes the report. Changes in health care information technology, such as broader adoption of electronic health records, could help health care providers and patients more quickly receive best practices information.

Funding for a national center for evidence-based medicine should come from a source not subjected to the annual appropriations process, such as national foundations and perhaps a consortium of other payers—with strict controls to prevent interference—contributing as well, the report's authors conclude.

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