1. Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b This material (Comp1_Unit9b) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. The Evolution and Reform of Healthcare in the US Learning Objectives 2 Describe evidence-based medicine, clinical practice guidelines, and quality indicators in medicine (Lecture a, b, c) Describe the patient-centered medical home model (Lecture d) Discuss the key issues driving healthcare reform in the US (Lecture e) Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

3. Clinical Practice Guidelines: Definition 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b Systematically developed statements Assist practitioner and patient decision- making Intended for specific clinical circumstances –Recommendations that are based on evidence obtained by conducting a systematic review –Guidelines define the role of specific diagnostic and treatment modalities in the diagnosis and management of a disease

4. Clinical Practice Guidelines: Purpose To help clinicians and patients make appropriate decisions about healthcare How do guidelines achieve this? –By specifying a set of generally accepted approaches –By defining appropriate practices Example of clinical practice guidelines dissemination website: –National guidelines clearinghouse http://www.guideline.gov/index.aspx http://www.guideline.gov/index.aspx 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

5. US Preventive Services Task Force (USPSTF) 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b Independent panel of experts in prevention and evidence-based medicine Composed of primary care providers Conduct scientific evidence reviews of a broad range of clinical preventive healthcare services Develop recommendations

6. USPTF Grades 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b –A The USPSTF recommends the service has High certainty of substantial net benefit Suggestions for practice: Offer or provide this service –B The USPSTF recommends the service has High certainty of moderate net benefit or moderate certainty of moderate to substantial net benefit Suggestions for practice: Offer or provide this service

7. USPTF Grades (continued) 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b –C: Recommends against routinely providing the service. Tailor recommendations to individual patients At least moderate certainty that the net benefit is small Suggestions for practice: Offer or provide this service only if other considerations support the offering or providing the service in an individual patient –D: Recommends against the service. Moderate or high certainty of no net benefit or that harms outweigh benefits Suggestions for practice: Discourage the use of this service

8. USPTF Grades (continued) 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b –I Statement: Current evidence is insufficient to assess the balance of benefits and harms of the service Suggestions for practice: Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms

9. The Evolution and Reform of Healthcare in the US Summary – Lecture b 9 Defined Clinical Practice Guidelines Described US Preventive Services Task Force (USPSTF) Described USPSTF grades of evidence Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b

10. The Evolution and Reform of Healthcare in the US References – Lecture b References Harris, R. P., Helfand, M., & Woolf, S. H., et al. (2001). Current methods of the US Preventive Services Task Force: a review of the process. American Journal of Preventative Medicine, 20 (suppl 3), 21-35. U.S. Preventive Services Task Force (USPSTF). (n.d.). Retrieved December 6, 2011, from U.S. Department of Health & Human Services - Agency for Healthcare Research and Quality website: http://www.ahrq.gov/clinic/uspstfix.htm http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force. (n.d.). Retrieved December 6, 2011, from U.S. Preventative Services Task Force website: http://www.uspreventiveservicestaskforce.org/http://www.uspreventiveservicestaskforce.org/ 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture b