The Evidence Gap

According to the Institute of Medicine, only half of what physicians do is backed up by valid research. Physicians (and consumers) often lack the necessary information to make good decisions about drugs, diagnostic tests and medical devices. Misleading, inconsistent and unreliable healthcare information contributes significantly to the $750 billion spent annually on unnecessary medical care. Here we look at how the evidence gap in American healthcare leads to underuse, overuse and misuse of healthcare services.

Treatment Trends in Type 2 Diabetes

An Epocrates MedInsight® Report

In 2011, medication costs for Type 2 diabetes reached $18.9 billion, a three-fold increase from the $6.7 billion spent in 2001. While these numbers reflect prescribing trends, such data does not reveal the underlying attitudes and perceptions that determine medication choices. This report, a collaboration between Epocrates, Stanford School of Medicine and RxBalance, examines current attitudes and perceptions of 50 U.S. primary care physicians regarding Type 2 diabetes management. These findings suggest ways in which knowledge gaps influence medication choices.

 

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The Quality of Health Care Delivered to Adults

A national study published in the New England Journal of Medicine in 2003 examined medical charts of over four thousand patients. The RAND Corporation found that patients in the study received only 55% of the preventive care and 54% of the acute care that evidence-based guidelines recommend.

 

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How Good Is the Quality of Health Care in the United States?

This review published in November 2005 reveals large gaps between the care people should receive and the care they do receive.  This seems to be the case for three major types of care — preventive, acute, and chronic. The gap exists whether one looks at overuse or underuse.

 

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National Healthcare Quality Report

The most recent National Healthcare Quality Report (August 2014) looked at healthcare quality indicators such as effectiveness, safety, and adequacy of health system infrastructure. On average, in 2010, Americans received 70% of indicated health care services and failed to receive 30% of the care needed to treat or prevent particular medical conditions. This gap between best possible care and what is routinely delivered in the U.S. varies based on geography, race, ethnicity and family income.

 

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Is More Care Better? The Problem of Overutilization

As counterintuitive as it may sound, more care is not always better care. Overuse refers to patients receiving care that is known not to be helpful and may even be harmful. According to this report, spending for lumbar spinal fusion rose 500 percent between 1993 and 2003, despite lack of evidence supporting effectiveness of back surgeries. Indeed, research shows that a combination of physical therapy and anti-inflammatory medication is often the most effective treatment for low-back pain and that many patients will see their symptoms resolve within three months.

 

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Health Care Spending, Quality and Outcomes: More isn’t Always Better

Over the past ten years, a number of studies have explored the relationship between higher spending on healthcare and the quality and clinical outcomes of the care provided. This 2009 topic brief from the Dartmouth Atlas points out that higher healthcare spending does not result in better quality of care. This applies whether one looks at the technical quality and reliability of care or survival following serious conditions such as heart attack or hip fracture.

 

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A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures

The sheer volume of published studies—more than 760,000 a year— makes it difficult for any individual physician to keep up with the literature. Pharmaceutical marketing can sometimes persuade doctors to ignore good science. At other times, physicians rush to use — and patients demand — a new device, surgical technique, or test long before evidence points to its safety and effectiveness. Vertebroplasty, a procedure which involves injecting bone cement into vertebrae, was put into widespread use despite a lack of evidence for efficacy. This 2009 study published in the NEJM showed that the procedure is no better at relieving back pain than sham surgery.

 

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