Advertisement

Evidence-based Medicine and Managed Care

  • Marion Danis
Chapter
  • 980 Downloads

Conclusion

The ethical issues that arise in the practice of EBM in managed care are not unique. Like other large health care organizations, MCOs must grapple with the combined ethical difficulties involved in identifying and rationing effective care. MCOs should develop guidelines that simultaneously steer effective care for their population as a whole and include permissible strategies for the individual provider to negotiate satisfactory patient-centered care.

On the other hand, MCOs are in a uniquely strong position to generate evidence. Hence, MCOs have a responsibility to realize that the nature of the evidence they generate can have a profound impact on medical practice. They should seek to generate evidence that promotes population health, attempts to fill the gaps in needed data, particularly for understudied segments of the population, incorporates patient utilities, and avoids undue influence from those who are marketing innovations, or from those who wish to cut costs without concern for good patient outcomes.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Anonymous (2000) Evidence-based Medicine helps providers offer cost-effective care. Capitation Management Report 7:88–90Google Scholar
  2. 2.
    Armstrong K, Eisen A et al. (2000) Assessing the risk of breast cancer. New England Journal of Medicine 342:564–570CrossRefPubMedGoogle Scholar
  3. 3.
    August P (2003) Initial treatment of hypertension. New England Journal of Medicine 348:610–617CrossRefPubMedGoogle Scholar
  4. 4.
    Beasley B, Wooley D (2002) Evidence-based Medicine knowledge, attitudes, and skills of community faculty. Journal of General Internal Medicine 17:632–639CrossRefPubMedGoogle Scholar
  5. 5.
    Bodenheimer T, Wagner E et al. (2002) Improving primary care for patients with chronic illness. JAMA 288:1775–1779PubMedGoogle Scholar
  6. 6.
    Brown G, Brown M et al. (2000) Health care in the 21st century: Evidence-based Medicine, patient preference-based quality, and cost effectiveness. Quality Managed Health Care 9:23–31Google Scholar
  7. 7.
    Cawood J, Morrow T (2001) Putting to use a clinical guideline for treating tobacco dependency. Managed Care Interface 14:79–83PubMedGoogle Scholar
  8. 8.
    CMS (2003) Centers for Medicare and Medicaid ServicesGoogle Scholar
  9. 9.
    Fullerton D, Atherly D et al. (2001) Showing outcomes and proving value brings success. Managed Care Interface 14:63–65PubMedGoogle Scholar
  10. 10.
    Gricar J, Langley P et al. (2002) Academy of Managed Care Pharmacy’s Format for Formulary Submission, AMCPGoogle Scholar
  11. 11.
    Holloway R, Benesch C et al. (2000) Stroke prevention: narrowing the evidence practice gap. Neurology 54:1899–1906PubMedGoogle Scholar
  12. 12.
    Hope T (1997) Evidence-Based Patient Choice. The King’s Fund, LondonGoogle Scholar
  13. 13.
    Hornberger J, Wrone E (1997) When to base clinical policies on observational versus randomized trial data. Annals of Internal Medicine 127:697–703PubMedGoogle Scholar
  14. 14.
    Ibrahim M, Savitz L et al. (2001) Population-based health principles in medical and public health practice. Journal of Public Health Managed Practice 7:75–81Google Scholar
  15. 15.
    Kongstvedt P (2001) Essentials of Managed Health Care. Aspen Publishers, GaithersburgGoogle Scholar
  16. 16.
    Matson C, Morrison R et al. (2000) A medical school-managed care partnership to teach Evidence-based Medicine. Academic Medicine 75: 526–527PubMedCrossRefGoogle Scholar
  17. 17.
    Maynard A (1999) Rationing health care: an exploration. Health Policy 49:5–11CrossRefPubMedGoogle Scholar
  18. 18.
    Mechanic D (2002) Socio-cultural implications of changing organizational technologies in the provision of care. Social Science and Medicine 54:459–467PubMedGoogle Scholar
  19. 19.
    NCQA (2002) NCQA: Measuring the quality of America’s health. NCQAGoogle Scholar
  20. 20.
    Overage J, Perkins S et al. (2001) Controlled trial of direct physician order entry: effects on physicians’ time utilization in ambulatory primary care internal medicine practices. Journal of the Medical Informatics Association 8:361–371Google Scholar
  21. 21.
    National Institutes of Health Consensus Development Panel (1997) National Institutes of Health Consensus Development Conference statement: Breast cancer screening for women ages 40-49, January 21-23, 1997. Journal of the National Cancer Institute 49:1015–1025Google Scholar
  22. 22.
    Parker M (2001) The ethics of evidence-based patient choice. Health Expectations 4:87–91CrossRefPubMedGoogle Scholar
  23. 23.
    Ramsey S, Luce B et al. (1998) The limited state of technology assessment for medical devices: Facing the issues. American Journal of Managed Care 4:SP188–SP199PubMedGoogle Scholar
  24. 24.
    Robinson R (2000) Managed care in the United States: a dilemma for evidence-based policy? Health Economics 9:1–7CrossRefPubMedGoogle Scholar
  25. 25.
    Sheingold S (1998) Technology assessment, coverage decisions, and conflict: The role of guidelines. The American Journal of Managed Care 4:SP117–SP125PubMedGoogle Scholar
  26. 26.
    Shortell S, Zazzali J et al. (2001) Implementing Evidence-based Medicine: the role of market pressures, compensation incentives. and culture in physician organizations. Medical Care 39:I62–78PubMedGoogle Scholar
  27. 27.
    Shye D, Porath A et al. (2000) Adapting a national guideline for local use: a comparative study in a US and an Israeli health maintenance organization. Journal of Health Services Research and Policy 5: 148–155PubMedGoogle Scholar
  28. 28.
    Sultz H, Young K (1999) Health Care USA: Understanding its Organization and Delivery. Aspen Publishers, GaithersburgGoogle Scholar
  29. 29.
    Tierney W, Dexter P et al. (2001) The effects of discussions about advance directives on patients’ satisfaction with primary care. Journal of General Internal Medicine 16:32–40CrossRefPubMedGoogle Scholar
  30. 30.
    Vakil N (2001) Evidence-based health care: making health policy and management decisions. Managed Care 10:22–24PubMedGoogle Scholar
  31. 31.
    Walshe K, Rundall T (2001) Evidence-based management: from theory to practice in health care. Milbank Quarterly 79:429–457CrossRefPubMedGoogle Scholar
  32. 32.
    Wehr E (2001) Evidence-based health coverage for children: proceed with caution. Ambulatory Pediatrics 1:23–27CrossRefPubMedGoogle Scholar
  33. 33.
    Whellan DJ, Cohen EJ, Matchar DB, Califf RM (2002) Disease management in healthcare organizations: results of n-depth interviews with disease management decision makers. American Journal of Managed Care 8:633–641PubMedGoogle Scholar
  34. 34.
    Zelman W, Berenson R (1998) The Managed Care Blues & How to Cure Them. Georgetown University Press, Washington DCGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2005

Authors and Affiliations

  • Marion Danis

There are no affiliations available

Personalised recommendations