Reliable clinical research is still missing piece of healthcare reform puzzle

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[Originally published by Hospital Impact – 2010]

When considering whether the healthcare reform is a success, industry observers often regard access and cost of care as the main criteria. But they may be leaving a critical component out of the equation.

Take the 2006 Massachusetts (Mass.) healthcare reform bill, which had reportedly led to 98+ percent of the state’s residents having health insurance–including 99+ percent of the state’s children.

So if the goal of healthcare reform in Mass. is to improve access to health insurance for people then the Massachusetts model can be considered a success.

On the other hand this healthcare reform bill has reportedly neither cut health care spending nor improved access to care.

Waiting rooms were overcrowded before, and they’re still overcrowded today, Ezra Klein notes in his Washington Post blog “How could health care reform look check Massachusetts”. And although people may now be able to go to a primary care doctor, those expensive emergency room visits have not dropped as predicted.

So if the goal of healthcare reform in Mass. is to decrease costs and increase access to appropriate care at the appropriate time and in the appropriate setting then the Massachusetts model cannot be considered a success. At least not yet.

But more than access and cost of healthcare need changing. You’ll see what I mean if we re-picture the healthcare reform efforts in Massachusetts and focus solely on access for a moment. Assuming that these reform efforts actually did improve access to the current “system”…ask yourself…access to what?

– Access to a model where a physician does not have easy access to unbiased, scientifically valid, trusted, and understood clinical research data?
– Access to a model where a physician does not have the time and skill set to critically review and assess the latest clinical research?
– Access to a model where the patient receives care/treatment recommendations based in many cases on “misleading, exaggerated, or flat-out wrong” clinical research?

What gets lost in the discussion of healthcare reform is the care. How good can a treatment be when up to half of the most acclaimed clinical research can’t be trusted according to Dr. John Ioannidis, who has challenged his peers’ misleading and simply wrong clinical research. In fact, he claims that 80 percent of non-randomized studies and 25 percent of randomized studies are wrong.

Add this to the Institute of Medicine’s claim that only about half of medicine is based on valid science. And it’s clear we have a great opportunity to significantly improve the healthcare paradigm and the care we provide to our communities.

Many amazing, caring physicians and other individuals are stuck in the broken healthcare “system” and it will take these and other selfless, caring, brilliant people who understand the keys and barriers to real healing to truly fix the care model.

To achieve that, they must understand valid science, optimal research methods and the critical need for accessible, valid, understood and trusted clinical research outcomes. It will take true leaders who can leverage adaptive and collaborative leadership skills to rise above the quagmire, the misaligned financial drivers, the egos, and the inherent biases of the current broken healthcare “system” to make a real and positive difference.

At a minimum (and as a start) we need to ensure the following elements of a new healthcare paradigm are in place:

1. Physicians must have easy access to unbiased clinical research experts
2. Physicians must be educated on how best to critically review, assess, and analyze the clinical research for themselves
3. Physicians must have the time to invest in assessing the latest research
4. Physicians must have the time and space to discuss the research data and resulting varied treatment options with trusted colleagues
5. Physicians must have the opportunity to leverage the now understood clinical research and discuss a challenging patient situation and/or a “best practice” in a safe setting with trusted colleagues
6. Physicians and patients must have the time and space to develop real relationships and trust where information flows freely
7. Physicians and patients must have the time and space to get to the root-cause of a symptom and co-create a treatment plan that is based on accessible, valid, understood, unbiased and trusted clinical research outcomes and which is best suited for the specific patient
8. Outcome goals and metrics for each specific patient must be developed together by the physician and patient, assessed regularly, and the treatment approach modified as appropriate (using a PDCA, or plan/do/check/act type approach), and again leveraging the now understood and trusted clinical research
9. Physicians must be compensated appropriately for all the above

Without valid, understood, trusted evidence-based clinical research, what are we truly providing access to?

Improved access to insurance is not enough and as seen in Massachusetts doesn’t lead to better access to care or expense reductions. Now is the time to implement these changes.

We can do better.

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