![]() Of entities offering healthcare guidance and advice if these organizations have conflicting interests. Full transparency and disclosure, as well as open and inclusive processes in the identification of research priorities, the formulation of research questions, and the development and application of evidence, are essential.Ĭonsumers believe that they are justifiably suspicious of the motivation Such a trusted intermediary for evidence could build and maintain public support by disseminating meaningful and reliable information.įor consumers and patients, trust in the process would be enhanced if research topics were significant and important to them. An independent, unbiased entity could potentially have the requisite credibility among all parties if it conducted investigations in accordance with acceptable scientific standards and operated in a fully transparent manner. The structure and process for generating evidence and evaluating comparative effectiveness must instill confidence among all stakeholders, including consumers-patients, that the research supporting the information is valid and fair. Yet, in general, the public is not aware of the concept of evidence-based medicine (EBM), nor does the current terminology used to describe the concept resonate with consumers when it is presented to them (Shore and Carman, 2006). Thus, they have a vested interest in seeing that the scientific basis for care expands. Even when it is available (for example, for pregnancy and childbirth), it is not widely applied or may be used or interpreted inconsistently.Īs the end users of health care, consumers and patients would realize great benefit from a reengineered healthcare system designed to achieve improved quality and safety as well as greater efficiency and cost reduction (Shortell et al., 2007). As a result, information on effectiveness is “almost never available” (Smith, 1991). ![]() Despite the potential that the development, dissemination, and implementation of better evidence holds for patients, the infrastructure and financing required to pursue the necessary research are lacking. A substantial portion of the medical care delivered in the United States is not based on or supported by evidence, although experts differ on the degree to which this is the case (Learning What Works Best, 2007). Inconvenient access to care, a lack of information to inform decision making, cultural and linguistic barriers, financial impediments to service, and, too often, the “tone” of the physician-patient relationship are just a few of the reasons for patient frustration and dissatisfaction.Įxacerbating the problems of escalating costs and quality gaps is the dearth of reliable evidence to inform clinician and patient decisions. In addition, as noted by the Institute of Medicine, patients are often frustrated with their inability to participate as full partners in their health care (Institute of Medicine, 2001). ![]() House Committee on Appropriations, Sub-Ĭommittee on Military Construction, Veterans Affairs, and Related Agencies, 2007) as well as regional differences in the use of supply-sensitive services (Regenstreif, 2005). A principal factor contributing to increasing long-term health expenditures is adoption of new technologies and innovations that have not undergone adequate scrutiny to determine comparative clinical or cost-effectiveness (Centers for Medicare and Medicaid Services, 2007 Davis et al., 2007 U.S. In the United States, 42 percent of people with chronic conditions report that they have skipped medications, not seen a doctor, or forgone recommended care because of costs (Schoen et al., 2007). Moreover, 47 million were uninsured (U.S. Although the decline between 20 was slight, the continuing trend is troubling. The percentage of those with employer-sponsored coverage dropped from 60.2 percent in 2005 to 59.7 percent in 2006 (U.S. As healthcare costs continue to escalate, employers and workers find it increasingly difficult to afford coverage. Since 2000, health insurance costs have increased by 87 percent (Kaiser Family Foundation/Health Research and Educational Trust, 2006). Although the United States spends more of its gross domestic product on health care than any other nation, higher spending does not necessarily yield better outcomes. Healthcare quality is, at best, uneven, with wide variation based on geography and patient characteristics, such as age, gender, race, and ethnicity.
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