Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 3 de 3
Filter
Add more filters










Database
Language
Publication year range
1.
J Comp Eff Res ; 3(6): 657-66, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25494572

ABSTRACT

The American Recovery and Reinvestment Act (ARRA) of 2009 directed US$1.1 billion to the US Department of Health and Human Services for support of comparative effectiveness research (CER). As part of this investment, US Department of Health and Human Services commissioned a midstream evaluation of the ARRA CER portfolio. One goal of the evaluation was to identify issues to consider for a future evaluation of the long-term impact of this portfolio and other CER investments. In planning the ARRA CER evaluation, we developed and revised a conceptual framework and related policy research questions that may be useful to future efforts to assess the impact of CER or patient-centered outcomes research investments. In addition, we explored methodological challenges related to designing an evaluation to assess investments in CER that may be informative to any future plans to evaluate the long-term impact of ARRA CER as well subsequent investments made from the Patient-Centered Outcomes Research Trust Fund.


Subject(s)
Comparative Effectiveness Research/economics , Research Support as Topic/economics , American Recovery and Reinvestment Act , Financing, Government/economics , Humans , Medicaid/economics , Medicare/economics , Policy Making , Publications/statistics & numerical data , Social Support , United States , United States Agency for Healthcare Research and Quality
2.
J Comp Eff Res ; 2(3): 249-59, 2013 May.
Article in English | MEDLINE | ID: mdl-24236624

ABSTRACT

This article reviews the recent research, policy and conceptual literature on the effects of payment policy reforms on evidence-based clinical decision-making by physicians at the point-of-care. Payment reforms include recalibration of existing fee structures in fee-for-service, pay-for-quality, episode-based bundled payment and global payments. The advantages and disadvantages of these reforms are considered in terms of their effects on the use of evidence in clinical decisions made by physicians and their patients related to the diagnosis, testing, treatment and management of disease. The article concludes with a recommended pathway forward for improving current payment incentives to better support evidence-based decision-making.


Subject(s)
Decision Making , Evidence-Based Medicine/economics , Fee-for-Service Plans/economics , Health Care Reform/economics , Point-of-Care Systems/economics , Cost-Benefit Analysis , Humans , Quality of Health Care/economics
3.
J Comp Eff Res ; 2(3): 235-47, 2013 May.
Article in English | MEDLINE | ID: mdl-24236623

ABSTRACT

This article develops a framework for understanding how financial and nonfinancial incentives can complicate point-of-care decision-making by physicians, leading to the overuse or underuse of healthcare services. By examining the types of decisions that clinicians and patients make at the point-of-care, the framework clarifies how incentives can distort physicians' decisions about testing, diagnosis and treatment, as well as efforts to enhance patient adherence. The analysis highlights contributing factors that promote and impede evidence-based decision-making, using examples from the 'Choosing Wisely' program. It concludes with a summary of how the existing fee-for-service payment system in the USA may contribute to the problems of over- and under-testing, diagnosis and treatment, highlighted through the efforts of Choosing Wisely.


Subject(s)
Fee-for-Service Plans/economics , Motivation , Point-of-Care Systems/economics , Practice Patterns, Physicians'/economics , Decision Making , Diagnostic Services/economics , Diagnostic Services/statistics & numerical data , Evidence-Based Medicine/economics , Health Services Misuse/economics , Humans , Physician-Patient Relations , United States
SELECTION OF CITATIONS
SEARCH DETAIL
...