. Clancy CM et al Evidence based decision making:global evidence local decision Health affairs Clancy CM et al, Evidence-based decision making:global evidence, local decision. Health affairs. 2005;24:151 Muir Gray, University of Oxford. Evidence-based decision-making is an essential element in the provision of health care for the 21 st Century.
J. Bruce Moseley, M.D. etc A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee. New Engl J Med. 2002:347:81-8888 # Harrison s Principles of Internal Medicine 15th Ed (2001)
A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee J. Bruce Moseley, M.D. New Engl J Med.
Corticosteroids prior to preterm delivery Reviewer: Crowley P January 1996
Statement on Issues to Be Considered Before New Surgical Technology is Applied to the Care of Patients t by the American College of Surgeons 1.? 2.? 3.? 4. -?
Halfway Technology
High Technology
The Way for Best Decision i Making Governing Rule Philosophy Information Value Affordability: Reality Decision Making Method
Governing Rule
Governing Rule European Countries: focus on safety, effectiveness and cost-effectiveness USA: CMS for Medicare: Reasonable and necessary -Social security Act, Title XVIII,section 1862(a)(1)(A) BCBSA: Medically necessary - 5 criteria Kaiser Permanente: Kaiser Permanente: Medically appropriate
Medically necessary
medically necessary/medical necessity
Blue Cross and Blue Shield Association medically necessary; 5 criteria
the Decreasing Variation in Medical Necessity Decision Making Sara Singer, et al. Center for Health Policy, Stanford University. it August, 1999
Effective ;? benefits / potential harmful effects. Health outcomes;? Scientific evidence; ; ( ) ; health outcomes? ;. the Decreasing Variation in Medical Necessity Decision Making Sara Singer, et al. Center for Health Policy, Stanford University. August, 1999
; (scientific evidence) ; the Decreasing Variation in Medical Necessity Decision Making Sara Singer, et al. Center for Health Policy, Stanford University. August, 1999
State Law Regulation of Medical Necessity S R b t l C t f H lth S i R h d P li D t t f H lth P li Sara Rosenbaum et al. Center for Health Services Research and Policy, Department of Health Policy, The George Washington University School of Public Health and Health Services. MEDICAL NECESSITY IN PRIVATE HEALTH PLANS. 2003
Massachusetts defines medical necessity as health care services that are consistent with generally accepted principles of professional medical practice. Mass. Ann. Laws ch. 176O (1) (2001).
Hawaii defines medical necessity if it is recommended by the treating physician or treating licensed health care provider, is approved by the health h plan s medical director or physician i designee, and is: (1) For the purpose of treating a medical condition; (2) The most appropriate delivery or level of service, considering potential benefits and harms to the patient; (3) Known to be effective in improving health outcomes; provided that: (A) Effectiveness is determined d first by scientific evidence; (B) If no scientific evidence exists, then by professional standards of care; and (C) If no professional standards of care exist or if they exist but are outdated or contradictory, then by expert opinion;and (4) Cost-effective for the medical condition being treated compared to alternative health interventions, including no intervention. For the purposes of this paragraph, cost-effective shall not necessarily mean lowest price. HRS 432E-1.4 (2000) (IRO Statute) This Hawaii s definition, enacted in 2000, is virtually identical to the prototype definition proposed in 1999 by Singer et al.
Value
Value
Committee - Decision Making Process
Carolyn M. et al Evidence-based decision making. Health Affairs. 2005;24:151
P Knipschild. Systematic Reviews: Some examples BMJ 1994;309:719-721
Data, Information, Knowledge, and Wisdom
Classification of content t of the human mind and Medicine
CARDIAC RESYNCHRONIZATION THERAPY
Data
Information
Knowledge
National Emphysema Treatment Trial (NETT)
CED
UK Decision Making Process Published evidence HEALTHCARE PROFESSIONAL GROUPS PATIENT GROUPS; GENERAL PUBLIC SOCIAL VALUE JUDGEMENTS Review of POLICY NHS; Evidence MAKING PUBLIC SECTOR Unpublished evidence??? ACADEMIA INDUSTRY Academic group or professional collaborating centre Standing independent advisory committee or ad hoc expert group
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