1 / 10

Comparative Effectiveness and Appropriateness

Comparative Effectiveness and Appropriateness. Thomas E Feasby MD Dec. 2, 2008. Appropriateness. Doing the right thing with a healthcare intervention (net positive effect) Measured by a process including best evidence, balanced expert opinion (panel), chart review of real cases

miyoko
Download Presentation

Comparative Effectiveness and Appropriateness

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Comparative Effectiveness and Appropriateness Thomas E Feasby MD Dec. 2, 2008

  2. Appropriateness • Doing the right thing with a healthcare intervention (net positive effect) • Measured by a process including best evidence, balanced expert opinion (panel), chart review of real cases • Method developed at RAND/UCLA in 1980s • Has been used to assess performance of many diagnostic and therapeutic interventions

  3. Appropriateness Examples • Carotid Endarterectomy • An operation on the carotid artery in the neck to prevent stroke • Intravenous Immunoglobulin (IVIG) • A blood product to treat immune and infectious diseases

  4. Western Canadian Carotid Endarterectomy Appropriateness Study • RAND/UCLA method • Canadian expert panel • 203 scenarios rated • reviewed 3000 charts from cases done in Manitoba, Saskatchewan, Alberta and British Columbia for 2000 & 2001 Kennedy, Quan, Ghali & Feasby, CMAJ 2004

  5. Western Canada Carotid Endarterectomy Appropriateness Study Overall Results Appropriate 52.3% Uncertain 37.4% (mostly asymptomatic) Inappropriate 10.3% (minimal stenosis or occluded) Kennedy, Quan, Ghali & Feasby, CMAJ 2004

  6. The Appropriateness of Intravenous Immunoglobulin (IVIG) • RAND method • Over 3000 cases in Alberta and British Columbia in 2001 and 2003

  7. Appropriateness IVIG Use by Province Feasby, Ghali, Quan, Pi and Tinmouth, 2008

  8. Appropriateness and Comparative Effectiveness Questions: Can it work? → Does it work? Concepts: (Efficacy) (Effectiveness) Methods: RCTs Comparative Effectiveness Appropriateness

  9. Appropriateness and Comparative Effectiveness Key Differences • Comparative Effectiveness studies examine how the appropriate use of efficacious interventions work in a diverse population • Appropriateness studies examine whether interventions are applied appropriately in a diverse population

  10. Conclusion • Healthcare interventions in the ‘real’ world are often used inappropriately, which reduces effectiveness • This needs to be taken into account in comparing the overall effectiveness of treatments and offers an avenue for improvement

More Related