Choosing treatment options for early stage prostate cancer is not like selecting the best electric screwdriver on the market, said Sean R. Tunis, M.D., keynote speaker at the 2012 Mid-Atlantic SGIM (Society of General Internal Medicine) regional meeting held March 16 at the John H. Ammon Medical Education Center on the Christiana Hospital campus.
More than 200 physicians attended the event titled “Generalism on the Front Lines: Defining and Delivering High-Value Care.” SGIM’s mid-Atlantic region comprises Delaware, Maryland, New Jersey, New York, Pennsylvania, Puerto Rico and Washington, DC.
Co-chairs of the conference were Christiana Care’s Daniel J. Elliott, M.D., MSCE, co-director of Ambulatory Medicine and Clinical Outcomes Research and Neeta P. Milasincic, M.D., director of the 4th Year Clerkship in the Department of Medicine.
Dr. Tunis, founder and director of the Center for Medical Technology Policy and past chief medical officer and director of the Office of Clinical Standards and Quality for the Centers for Medicare and Medicaid Services (CMS), spoke about “Defining High-Value Health Care through Comparative Effectiveness Research.”
While there is ample comparative information to help consumers choose a screwdriver, there are serious limitations in the body of evidence to help patients decide on a course of treatment for many different diseases, he said.
Dr. Tunis said CMS recruited him to create an evidenced-based policy making system for Medicare and Medicaid programs. He collected, reviewed and analyzed scientific literature related to paying for treatments such as a PET scan for Alzheimer’s disease or a defibrillator for cardiac care. “Every systematic review of the literature handed to us had serious defects that left significant uncertainties in what we could recommend,” he said.
Dr. Tunis advocates for comparative effectiveness research, which, he said, reduces the gaps in evidence if projects engage the decision makers themselves – patients, practicing clinicians and payers – to determine the most important unanswered questions.
Comparative effectiveness research must:
- Inform clinical or health policy decision.
- Compare at least two alternatives, each with potential to be best practice.
- Achieve results at population and subgroup level.
- Measure outcomes important to patients.
- Use methods and data sources appropriate for the decision of interest.
- Be conducted in real world settings, not just under optimal conditions.
“If a research study does not actively incorporate the decision makers and other key stakeholders in defining what the questions are, it probably isn’t comparative effectiveness research,” he said.
Robert Laskowski, M.D., Christiana Care president and CEO, welcomed attendees to the conference. “This is the most exciting time of my professional career,” he said. “I’ve spent a large part of my career figuring out ways to improve the way we care for people. For the first time, I see the big picture changing. We need to think bold thoughts and work like crazy to bring those thoughts to reality,” he said.
“Three decades from now,” Dr. Laskowski continued, “we will look at this time with general internal medicine being at the forefront of how American medicine reinvented itself, and, in the process, reinvented medicine for the entire world.”
Julie Silvestein, M.D., chief of General Internal Medicine at Christiana Care, moderated a panel discussion on “The Future of General Internal Medicine.” Panelists agreed that general internists will turn to new technologies, including telemedicine, to reach patients.
“One of the beauties of general internal medicine is the ability to innovate,” said panelist Katrina Armstrong, M.D., division chief of General Internal Medicine at the University of Pennsylvania. Her message to young general internists: “Have a dream and carry it forward. Pick a problem and pursue it.” General internists will lead the change that is coming in medicine, she said.
Tabassum Salam, M.D., associate program director of the Internal Medicine Residency Program, presented her work “Using a Standardized Adaptive Clinical Encounter for Interprofessional Team Training” in a session about innovations in medical education. Deborah Ehrenthal, M.D., director of Health Services Research for Women and Children at Christiana Care, was awarded the Best Oral Presentation for her work “The Influence of Maternal Factors on Early Childhood Obesity.”
Christiana Care’s Value Institute sponsored the poster tour.
Photo gallery: 2012 SGIM regional meeting
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