ACP initiative to provide evidence-based recommendations for clinical problems

The American College of Physicians (ACP) plans to provide physicians and patients with evidence-based recommendations for a variety of clinical problems. According to ACP, its High-Value, Cost-Conscious Care initiative will assess benefits, harms, and costs of diagnostic tests and treatments for various diseases to determine whether they provide good value.

“Although it is easy to think of ACP's High Value, Cost-Conscious Care initiative as being driven purely by the need to contain ever-escalating healthcare costs, what we are really striving for is optimal care for our patients,” says Steven Weinberger, MD, FACP, Deputy Executive Vice President and Senior Vice President, Medical Education and Publishing, ACP. “We believe that such evidence-based care - which includes minimizing care that is overused or misused - simultaneously improves care while significantly reducing healthcare expenditures.

“Changing the current paradigm of care means engaging both physicians and patients in the effort. For physicians, it's recognizing when certain diagnostic tests are unnecessary and don't contribute to the overall care of the patient, or can be replaced by other, equally effective, but less costly diagnostic tests. For patients, it's a matter of changing expectations - good care is not defined by more care, it's defined by the right care at the right time.”

But some physicians may view efforts such as ACP’s initiative as threatening to usurp their individual approaches to providing care depending on each patient’s needs. Weinberger says evidenced-based care takes the doctor-patient relationship into account.

“Cost-conscious, evidence-based care should not be considered the same as ‘cookbook medicine,’” says Weinberger. “Providing optimal care for patients does not mean an approach to care that is recipe-driven according to a rigid cookbook. Rather, it is patient-centered, involving mutual understanding and shared decision-making by patient and physician, based upon evidence regarding those care options that work, those that don't work, those that are worthwhile, or those that don't add value to care or to patient outcomes, but just add unnecessary costs.”

The initiative will include the development of ACP's High-Value, Cost-Conscious Care Recommendations by ACP's Clinical Efficacy Assessment Technical Advisory Committee that will be submitted for review and consideration for publication in Annals of Internal Medicine. According to ACP, the effort will address common medical conditions for which inappropriate use of resources is known to be an issue, such as low back pain.

The next edition of ACP's Medical Self-Assessment Program will also have a focus on optimal diagnostic and treatment strategies, based upon considerations of value, effectiveness, and avoidance of overuse and misuse. Additional phases of the initiative may include patient education materials and curricula for medical students and residents.