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Policy, Guidelines, and Disparities. Peter B. Bach, MD, MAPP Memorial Sloan-Kettering Cancer Center bachp@mskcc.org. Overview. The goal of practice guidelines is to: Improve the quality of care? Manage care? Save money? Monitor the quality of care? Reduce disparities?

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Policy guidelines and disparities

Policy, Guidelines, and Disparities

Peter B. Bach, MD, MAPP

Memorial Sloan-Kettering Cancer Center

bachp@mskcc.org


Overview
Overview

  • The goal of practice guidelines is to:

    • Improve the quality of care?

    • Manage care?

    • Save money?

    • Monitor the quality of care?

    • Reduce disparities?

    • Give academics (with weird skills) something to do?


Improve care quality
Improve care quality

  • Underlying assumption: care is sub-standard

  • Practice guidelines used broadly would raise average level

  • Have to assume that deviations from guidelines net harmful

    • As opposed to important personalization

  • Clinical decision support can have a guidelines background



Manage care oncology example
Manage care (oncology example)

  • Pathways tell doctors which treatments to use in common conditions

  • Mostly payer contracts linked to pathways ask for 80% adherence












Policy guidelines and disparities

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280536.htmhttp://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280536.htm


Then there s the dissemination challenge

Then there’s the dissemination challengehttp://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280536.htm


Policy guidelines and disparities

Two Views of the Population Benefithttp://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280536.htm

Laurie Fenton Ambrose

President and CEO

Lung Cancer Alliance

Straight Extrapolation from the NLST

80,000 avoided deaths/yr


Dissemination challenge
Dissemination Challengehttp://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280536.htm

  • Available to anyone 50 years of age or older with a history of smoking or second hand smoke exposure

  • $199 for an individual,

  • $299 for a couple

  • Available to: “Patients…age 40 and over, typically with a history of smoking of at least 100 cigarettes in a lifetime.”

  • $399

  • http://www.sequoiahospital.org/Medical_Services/Cancer_Care_and_Early_Detection/SDR2_M177128

“The findings were INDISPUTABLE, “low dose” Lung CT saves lives by 20%.”


Thank you

Thank youhttp://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm280536.htm