9781284197709_PPTX_CH28

Chapter 28: Health Services Research: Finding What Works

28.1 Small-Area Analysis

• Small-area analysis highlights significant variations in medical practice styles across different geographical areas.

• Greater variations occur for conditions with limited knowledge regarding effective diagnostics and treatment approaches.

• Appropriate therapeutic options may vary, leading to different treatment pathways for similar conditions.

• Physicians might modify their practice when made aware of prevailing treatment patterns amongst peers.

28.2 Field of Dreams Effect

• Increased availability of medical services directly correlates with higher utilization rates.

  • Example: An increase in back surgeons leads to more back surgeries performed.

  • Increased hospital beds are associated not just with more admissions but also with higher death rates in hospitals compared to at home.

• Financial considerations can often influence medical decision-making processes.

28.3 Outcomes Research

• Outcomes research focuses on the epidemiologic study of medical care.

• It analyzes data from routine medical practices, such as Medicare records.

• The intent is to enable patients to make informed choices based on personal values.

  • Example: Benign prostatic hyperplasia (BPH) illustrates a high variation in procedures with options like watchful waiting versus prostatectomy.

  • Findings suggest prostatectomy's benefits are often overstated while complications are minimized.

  • Rising use of PSA screening for prostate cancer results in increased invasive test rates without proven reduction in mortality rates.

28.4 Agency for Healthcare Research and Quality (AHRQ)

• Established by Congress in 1989, aimed at developing treatment guidelines.

• Experienced significant political pressure when advocating for reduced back surgeries in 1994 but has since stabilized.

• Currently focuses on enhancing medical outcomes while managing healthcare costs effectively.

28.5 Medical Errors

• The 1999 Institute of Medicine report brought attention to serious medication errors and wrong-side surgeries.

  • Estimated 44,000–98,000 deaths annually due to medical errors.

  • The report emphasized the need to shift blame from individuals to systemic improvements.

• Key recommendations included:

  • Formation of the Center for Patient Safety.

  • Establishing national goals, tracking progress, and conducting research.

  • Investigation and reporting of medical errors.

  • Changes in drug naming, labeling, and packaging to reduce confusion.

28.6 Medical Care Report Cards

• Easier evaluation of managed care plans due to available data and annual reports.

• Report cards can assess care quality for specific procedures, such as:

  • Outcomes of coronary bypass surgeries monitored in New York State.

  • Comparative reports on hospitals and surgeons have led to improved outcomes, revealing that higher volume practitioners tend to achieve better results.

28.7 Inequities in Medical Care

• Access to medical care often correlates with a patient's ability to pay, leading to inequities.

• Racial disparities exist in healthcare, often resulting in poorer treatment for Black and Hispanic populations, even when financial means are equal.

  • Example: Minority groups less frequently receive mammogram recommendations.

• The Institute of Medicine acknowledges prevalent biases, prejudices, and stereotyping in healthcare delivery.

28.8 Relative Importance of Medical Care for Public Health

• International studies suggest a correlation between wealth (GDP) and health outcomes.

• Increased healthcare spending does not guarantee improved health; in some cases, it can even worsen mortality rates.

  • The RAND Health Insurance Experiment found that generous insurance coverage can result in wastage of services, whereas free access significantly benefits low-income and chronically ill individuals.

28.9 Discussion Questions

Discussion Question 1

• Consider reasons for treatment variance across geographic areas and the governmental role in addressing this issue.

Discussion Question 2

• Explore how outcomes research can enhance population health.

Discussion Question 3

• Discuss the impacts of human biology, lifestyle, environment, and medical care on population health.

Discussion Question 4

• Investigate recent issues highlighted by the AHRQ on their website.

Discussion Question 5

• Review the latest findings from Cochrane’s organization regarding outcomes research.