Jim Trevis: Why Do Many Oppose Evidence-based Health Care?

In my role as director of communications with ICSI, I get to see real collaborative work done between providers, health plans and patients to improve the quality and lower the cost of health care. For nearly 18 years doctors have used our evidence-based health care guidelines around the world to deliver high-quality care for patients with illnesses ranging from asthma to congestive heart failure.

We just launched a statewide initiative that enables providers to order appropriate high-tech diagnostic imaging (HTDI) scans (CTs, MRIs, etc.) while with the patient.

This approach loads appropriateness criteria from the American College of Radiology (ACR) and other specialty medical societies into a clinic’s electronic medical record (EMR) system or makes these criteria available through a secure Web site.  The criteria help the doctor order the appropriate HTDI procedure based on the patient’s condition.

Five of Minnesota’s leading medical groups have used this “decision-support” approach for almost four years. Nearly 4,000 providers have ordered more than 1 million scans in that time.  The results: this approach improved the diagnostic value of HTDI scans ordered, reduced patient exposure to unnecessary radiation, improved patient satisfaction, resulted in earlier diagnoses for patients, made clinics much more efficient, and helped reduce the use of inappropriate scans to the tune of $28 million in savings annually in Minnesota. These results are positive for the patient, provider, payer, employer and the Minnesota community.  It seems to be a prime example of achieving the Triple Aim of increasing the quality of care, decreasing per capita costs and improving the patient’s care experience.

The Minneapolis Star Tribune recently ran a front-page story on our initiative (http://bit.ly/bhRovO).  The reporter captured the gist of the initiative and its benefits. I went on line to gauge the public’s reaction to the news. There were positive comments.  But also references to death panels.  Killing grandma. Machines are delivering medicine vs. doctors.  Garbage in, garbage out.

This was discouraging because I know how hard stakeholders in Minnesota health care had worked to bring this positive initiative to launch, and how a few oft-repeated phrases could label the initiative inaccurately.  For example, how do death panels apply here?  It seems just the opposite, as D.J. Brenner and E.J. Hall estimated exposure to unnecessary CTs might cause 1.5% of the cancers in the U.S. in a New England Journal of Medicine article. Based on the reduction in unnecessary CTs due to this work in Minnesota, this initiative may have prevented 50 people from getting cancer.

So why would some commenters be opposed to using ACR criteria to help ensure the appropriate ordering of diagnostic scans?  On a larger scale, why are many opposed to rely on “evidence” in health care when evidence is relied on in so many other areas?

Let’s look at the legal system.  If you were a juror on a murder trial and your decision would help decide if the accused was set free or received the death penalty, you would be instructed to base your decision “on the evidence.”  You would listen to expert testimony, perhaps be given DNA, fingerprint or other evidence enabled by science and technology.  Prosecutors and defenders would rely on previous similar cases (evidence/standards) to build their case.  You would not want to make a mistake because a person’s life was at stake.  Yet, without the evidence, it would be difficult to know if you were making the right call.

You can apply this line of thinking on the importance of evidence to any other industry.  So why the backlash in health care?  Are we against evidence?  Or are we just against health care reform or, more simply, against change itself?

Whatever the reason, if we believe in providing higher quality and more affordable health care, if we believe in evidence-based care, we need to become more vocal about it. When stories like the one on our HTDI initiative appear, we need to not only read them but comment on them.  We need to lace our messages with facts and evidence. We need to be vocal about the good work we are doing to achieve the Triple Aim.