Rocky Mountain Workshop (2nd) on How to Practice Evidence-Based Health Care.

摘要

The goal of this research was to identify the managed care mechanisms that influence the extent to which medical innovations change medical practice. We focused on practice patterns for patients with coronary artery disease (CAD) in four diverse delivery systems. The research faced many hurdles that delayed the data collection and analysis. The interviews have been transcribed and analysis is ongoing. We plan to complete a manuscript this academic year. In total we interviewed 27 individuals, including physicians and administrators from health plans and physician groups. Preliminary results, based on unsystematic review of the interviews, suggest that managed care plans are hesitant to micro manage physician practices in clinical areas in which they do not have clear evidence. Most of the effect of managed care comes through more general pressure placed on physician groups. In the absence of evidence, authority lies with the physicians. Physicians are very aware of evidence, but willing to adopt technology prior to strong evidence if there is reason to believe the technology might resolve known clinical concerns and if anecdotal evidence suggests it may help. These results may change. Final results will be reported in several ways, including academic publications and presentations at professional meetings.