0~NM1A ACTIVITIES MEDICAL TREATMENT EFFECTIVENESS PROGRAM (MTP Jesse B. Barber, MD Washington, DC
The Medical Treatment Effectiveness Program (MTEP) of the Department of Health and Human Services for fiscal year 1990 has been said to mark a "new phase" in medical effectiveness research. This phase would "help physicians deliver the best care," as well as reducing unnecessary or ineffective treatment, according the HHS Secretary, Dr Louis Sullivan. Dr Sullivan suggested that as much as 25% of medical care may be unnecessary. A recent publication of the American Association of Medical Colleges, "Medical and Patient outcomes and Quality of Care Assessment," describes the problem as ". . . There is increasing evidence that some patients receive unnecessary or inappropriate services and others fail to receive needed beneficial services." Marked geographic variations in medical care use and costs between Boston and New Haven have been described. Though demographically similar to New Haven, in 1982, Boston spent $889 per person for inpatient care, while New Haven spent only $451. Higher admission rates and increased use of inpatient hospital beds resulted in $300 million greater hospital expenditures for Boston, due to widely varying patterns of practice. J. Jarrett Clinton, MD, MPH, newly-appointed Acting Director of the National Center for Health Dr Barber is Secretary of the Council on Medical Legislation of the NMA. Requests for reprints should be addressed to Dr Jesse Barber, Division of Neurosurgery, Howard University Hospital, 2041 Georgia Ave, NW, Washington, DC 20060. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
Services Research, described the MTEP for the 1990's within the Public Health Service (PHS) and in collaboration with the Health Care Financing Administration (HCFA). Four programs form the basis of MTEP: 1. Collection and development of data to link Medicare files with other data bases. 2. Research on patient outcomes and clinical effectiveness to evaluate specific treatments via small area analysis and multidisciplinary epidemiological research. 3. Dissemination and assimilation of findings through journals, publications, information networks, and conferences. 4. Development of practice guidelines through participation of professional (eg, AMA) and speciality organizations (eg, ACP); scientific bodies (eg, IOM); academic medical centers; standard setting organizations (eg, JCAHO); quality measurement organizations (eg, PRO) and research-based organizations (eg, American Medical Review Research Center). Research priorities are categorical conditions, such as breast cancer and myocardial infarction, but consideration of effectiveness of non-physician health providers and effectiveness of preventive services are also on the agenda. New patterns of collaboration were also mentioned. Dr Clinton described some criticisms of the program for which the Bush administration requested $52 million for 1990. Among them were: 169
MEDICAL TREATMENT EFFECTIVENESS PROGRAM
1. Organized medicine resists guidelines and parameters ("cook book" medicine). 2. "True Science" is found only in randomized clinical trials. 3. Insufficient researchers. 4. Collaborative effort problems for the health service research community; social scientists should work with physicians. 5. PRO data bases in varying states are too dissimilar. From the perspective of the poor and minority patients and their providers, other criticisms are pertinent, as determined by review of the HHS grants for MTEP, and by the presentation of Dr Clinton at the National Working Forum on Outcomes and Quality of Care. These include: 1. The well-justified emphasis on dissemination of findings fails to mention mechanisms of reaching
2. 3.
4.
5.
the providers who primarily care for poor and minority populations. This also is true for some existing projects. The research on patient outcomes and clinical effectiveness seems to exclude socioeconomic risk factors, despite their importance. One would hope that the collaborative approach should be focused on specific problems relating to preventable and correctable problems, such as infant mortality, excess deaths, violence and homicide, and access. No effort has been made as of this date, to the best of my knowledge, to involve minority and/or public hospital physicians or organizations. The relationship between MTEP, ambulatory care, and quality improvement is poorly understood.
Acadiana Chapter Established In May 1990, the Acadiana Chapter of Lafayette, Louisiana was approved as a component Society of the National Medical Association. The Chapter was organized February 2, 1990 at Prudhomme's Restaurant in Lafayette. Ernest W. Kinchen, Jr, MD, of Lafayette was named as the chapter's first president.
170
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
The Medical Treatment Effectiveness Program (MTEP) of the Department of Health and Human Services for fiscal year 1990 has been said to mark a "new phase" in medical effectiveness research. This phase would "help physicians deliver the best care," as well as reducing unnecessary or ineffective treatment, according the HHS Secretary, Dr Louis Sullivan. Dr Sullivan suggested that as much as 25% of medical care may be unnecessary. A recent publication of the American Association of Medical Colleges, "Medical and Patient outcomes and Quality of Care Assessment," describes the problem as ". . . There is increasing evidence that some patients receive unnecessary or inappropriate services and others fail to receive needed beneficial services." Marked geographic variations in medical care use and costs between Boston and New Haven have been described. Though demographically similar to New Haven, in 1982, Boston spent $889 per person for inpatient care, while New Haven spent only $451. Higher admission rates and increased use of inpatient hospital beds resulted in $300 million greater hospital expenditures for Boston, due to widely varying patterns of practice. J. Jarrett Clinton, MD, MPH, newly-appointed Acting Director of the National Center for Health Dr Barber is Secretary of the Council on Medical Legislation of the NMA. Requests for reprints should be addressed to Dr Jesse Barber, Division of Neurosurgery, Howard University Hospital, 2041 Georgia Ave, NW, Washington, DC 20060. JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
Services Research, described the MTEP for the 1990's within the Public Health Service (PHS) and in collaboration with the Health Care Financing Administration (HCFA). Four programs form the basis of MTEP: 1. Collection and development of data to link Medicare files with other data bases. 2. Research on patient outcomes and clinical effectiveness to evaluate specific treatments via small area analysis and multidisciplinary epidemiological research. 3. Dissemination and assimilation of findings through journals, publications, information networks, and conferences. 4. Development of practice guidelines through participation of professional (eg, AMA) and speciality organizations (eg, ACP); scientific bodies (eg, IOM); academic medical centers; standard setting organizations (eg, JCAHO); quality measurement organizations (eg, PRO) and research-based organizations (eg, American Medical Review Research Center). Research priorities are categorical conditions, such as breast cancer and myocardial infarction, but consideration of effectiveness of non-physician health providers and effectiveness of preventive services are also on the agenda. New patterns of collaboration were also mentioned. Dr Clinton described some criticisms of the program for which the Bush administration requested $52 million for 1990. Among them were: 169
MEDICAL TREATMENT EFFECTIVENESS PROGRAM
1. Organized medicine resists guidelines and parameters ("cook book" medicine). 2. "True Science" is found only in randomized clinical trials. 3. Insufficient researchers. 4. Collaborative effort problems for the health service research community; social scientists should work with physicians. 5. PRO data bases in varying states are too dissimilar. From the perspective of the poor and minority patients and their providers, other criticisms are pertinent, as determined by review of the HHS grants for MTEP, and by the presentation of Dr Clinton at the National Working Forum on Outcomes and Quality of Care. These include: 1. The well-justified emphasis on dissemination of findings fails to mention mechanisms of reaching
2. 3.
4.
5.
the providers who primarily care for poor and minority populations. This also is true for some existing projects. The research on patient outcomes and clinical effectiveness seems to exclude socioeconomic risk factors, despite their importance. One would hope that the collaborative approach should be focused on specific problems relating to preventable and correctable problems, such as infant mortality, excess deaths, violence and homicide, and access. No effort has been made as of this date, to the best of my knowledge, to involve minority and/or public hospital physicians or organizations. The relationship between MTEP, ambulatory care, and quality improvement is poorly understood.
Acadiana Chapter Established In May 1990, the Acadiana Chapter of Lafayette, Louisiana was approved as a component Society of the National Medical Association. The Chapter was organized February 2, 1990 at Prudhomme's Restaurant in Lafayette. Ernest W. Kinchen, Jr, MD, of Lafayette was named as the chapter's first president.
170
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION, VOL. 83, NO. 2
