IMAP, with a grant from the Selz Foundation, is addressing the issue of stewardship of health care resources from the perspective of the public/consumer. Our goal is to guide the public to view health care through the lens of evidence-based medicine; leading consumers to make better decisions, enhance the quality of their care, and optimize the use of health care resources.
Findings from surveys and focus groups demonstrate how deeply resistant Americans are to any limitations on the care they receive from medical personnel and institutions. The prevailing belief system can be easily summarized: more diagnostic and treatment interventions are always better; newer and more expensive medicines are always better; and efforts to establish practice guidelines that reflect evidence-based research on the effectiveness of interventions are a plot to ration medical care.
To make the problems even more compelling, the newly enacted Patient Protection and Affordable Care Act devotes little attention to promoting quality of care or reining in medical costs. The bill includes funding for several pilot projects that aim to utilize evidence-based medicine and reduce expenditures (for example, the Patient-Centered Outcomes Research Institute and Accountable Care Organizations). However, these initiatives are not weighted or prioritized because there is no consensus in the bill on appropriate methods for raising quality and curbing costs.
The project is undertaking several different approaches to these issues. These include:
• Framing the message to consumers in personal terms, not as an abstract appeal to such concepts as the patient as citizen.
• Exploring areas where the overuse of procedures and resulting harms is extensive and persuasive such as CT scans, cardiac stents, and the overprescription of antipsychotics for children.
• Responding effectively to patient advocacy groups, many of whom are the best organized publicists for the idea that “more is always better.”