Practice policies - what are they?

Article Abstract:

Practice policies refer to guidelines that have been set up as recommendations to assist the physician in making the best decision regarding the treatment of his patient. Because most health decisions are quite complicated, the assessment of each phase of the decision would be overly time consuming, too complicated and ineffective. While some unique situations do arise, many 'generic' decisions recur on a regular basis. Two examples of the latter are provided in which the usefulness of practice policies is demonstrated. In recent years, practice policies have received much attention from groups like the American Medical Association, the National Institutes of Health, as well as insurance providers and research groups. This attention is justified, as practice polices may be considered the central nervous system of clinical medicine. The enormous impact a policy may have is demonstrated by the positive results in patient care achieved by adopting the practice of washing hands between patients. Conversely, a poor policy can have just as powerful an impact, such as the tendency to continue to perform caesarean deliveries, whether or not they are indicated, if a women required one in the past. This also demonstrates how practice policies can shape the behavior of doctors long after a particular standard procedure has been questioned. The focus upon practice policies is not new. The use of practice policies has been a part of medicine for centuries, but there are two new changes that will significantly affect these procedures. These policies are being used to assure more "quality control" over medical treatment, which is sometimes perceived by the physician as a tool for outside interference. The way in which these policies are created is also different. They used to evolve over time, but now they are formed more rapidly by committees or panels using agendas and budgets. The methodology employed to formulate practice polices will inevitably affect the quantity and nature of the new policies that are produced. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Medicine, Practice, Clinical medicine, Medical practice, column

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Cost-effectiveness analysis: is it up to the task?

Article Abstract:

Oregon recently used cost-effectiveness analysis to decide which treatments and procedures will be reimbursed by Medicaid and which will not. Cost effectiveness can be defined as the benefit derived from a treatment compared to its cost. There may be questions about the methods used to estimate cost effectiveness. It may be hard to measure benefits when comparing different treatments that may result in different outcomes. It may be even more difficult if there are no studies in the medical literature to evaluate a treatment. And it may be hard to estimate the costs of a treatment, which can vary from hospital to hospital and must take long-term outcomes into account. Cost-effectiveness analysis works best when used with very specific diseases and treatments. Oregon's plan includes many broad categories. Oregon officials could produce a more detailed list of the most cost-effective treatments.

Methods, Cost benefit analysis, Health care rationing

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Investigational treatments: how strict should we be?

Article Abstract:

Managed care organizations need to use strict criteria to decide whether a treatment is considered investigational. By definition, investigational treatments are those for which there is insufficient evidence documenting their effectiveness. Criteria for determining whether treatments are investigational are included. Just because a treatment is investigational does not mean that the plan should not cover it. However, once a treatment is covered, it becomes an accepted treatment and little research is done to determine its effectiveness.

Contracts, Medical care, Quality management, Medical care quality, Medical research, Health insurance, Managed care plans (Medical care)

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