Knowing What Works in Health Care

Jan 29, 2008, 9:10 AM, Posted by RWJF Blog Team

The IOM last week released a new report calling for an independent entity to assess clinical effectiveness and provide credible, unbiased information about what really works in health care. The report was commissioned by RWJF and Risa Lavizzo-Mourey, our president and CEO, issued a statement calling the IOM right to emphasize that the future of health care quality and safety rests on the strength of the evidence we collect, and on our ability to channel that evidence to providers, policy-makers, payers and consumers to help them make better decisions.”

Despite our tremendous medical advances, in reality we too often don’t know which treatment, policy or mix of approaches really works to improve people’s health in this country. As Lynn Etheredge, with the Rapid Learning Project at George Washington University, says, we are developing technologies faster than we know how to use them. We cannot say whether we are getting value for the high costs we pay. Ultimately, these pervasive evidence gaps contribute to the wide variation we see in the quality, costs and outcomes of care experienced by patients, and this makes a huge difference in people’s health.

The report’s call to action, if heeded by policy-makers and other stakeholders, would drive forward the field of comparative effectiveness research, which requires rigorous evaluation of the costs, risks and benefits of different treatment options for different medical conditions in different sets of patients.

Such studies, we think, can be done quickly and inexpensively using existing data. To support this vision, the Foundation is promoting the concept of a rapid-learning health care system – one that draws on large electronic health record databases (think Kaiser Permanente and the VA) that represent the experience of millions of patients. Harnessing the cumulative data power within a rapid-learning system would dramatically speed clinical research, supply needed knowledge about the value of existing and new medical technologies, and provide better safety surveillance.

At the same time, we’ve funded David Eddy, founder of Archimedes, Inc. to build the ARCHeS interface, which will enable far more decision-makers to use the predictive mathematical modeling power of the Archimedes model to answer a potentially limitless number of key health care questions.

We hope the IOM report helps the nation rally attention and resources toward strengthening the research and evidence base in health care. If reliable, unbiased and transparent evidence can be put in the hands of providers, policy leaders, patients, insurers and other key actors, it will go far toward creating a higher quality, safer and more cost-effective system for all.