Problems With Medical Decision-Making
At the Foundation for Informed Medical Decision Making, a cornerstone of our work is improving decision quality. To achieve quality in medical decision-making, a patient must be informed and feel confident that the decision matches the values and preferences he or she deems to be important.
We believe the current system for making medical decisions is hampered by a number of ethical, safety, and variation problems that seriously diminish the quality of medical decisions.
Ethical Concerns
A recent survey of patients conducted by the University of Michigan found that fewer than one in five was asked by their health care provider about their preferences for care. Less than 50% were able to answer basic questions about their condition and its treatment—information that a truly informed patient would understand prior to making a treatment decision. The survey also found that providers often neglected to tell patients about the potential disadvantages of treatments or tests that they recommended.
At The Foundation for Informed Medical Decision Making, we believe it is an ethical right of every patient to be informed and involved in decisions that could affect their health or well-being. We believe that patients should have the opportunity to learn about all relevant treatment options and to engage in an active shared decision-making process in which they communicate their values and preferences to their health care provider.
Safety Issues
Patients who are not well informed when making important medical decisions—because they were not fully informed about either the technical aspects of the treatment or the relative risks and benefits of alternative options—may choose treatments with a greater risk of adverse consequences than they might otherwise have chosen. At The Foundation for Informed Medical Decision Making, we believe that without adequate knowledge of the risks and benefits associated with all treatment options, patients may be exposed to risks or experience harm that they would not choose to avoid if they were informed.
Problems Associated with Unwarranted Variation in Care
The current health care system demonstrates significant regional variation in care, which in some cases results in overuse of medical procedures and treatments—and overspending. Across the United States, there are large and often puzzling variations in medical expenses, treatment patterns, and quality. Much of this geographic variation has proven to be unwarranted; that is, it cannot be adequately explained by differences in illness rates, patient preferences, or the dictates of evidence-based medicine. At the Foundation for Informed Medical Decision Making, we believe that medical decisions made by informed patients offer great potential to reduce this problem.
The Dartmouth Atlas Project
Unwarranted medical practice variation has been studied and documented by researchers at Dartmouth under the direction and leadership of John E. Wennberg, MD, MPH. Researchers involved with the Dartmouth Atlas Project have been providing continuous feedback of population-based information describing resource inputs, utilization, and outcomes of care among the more than 3,000 hospital service areas and 306 hospital referral regions in the United States.
Distribution and Use of Medical Resources in the United States
Using up to 12 years of Medicare data, the Dartmouth Atlas Project seeks to accurately describe how medical resources are distributed and used in the United States. It has not only demonstrated glaring variations in how health care is delivered across the nation, but also has shown that patients in regions with greater levels of spending and use of physician visits and hospitalizations do not experience better health care outcomes or quality of care. The research findings from the Dartmouth Atlas have led to legislation promoting demonstration projects to address unwarranted variations in the care provided to Medicare patients. The Dartmouth Atlas is a rich source of information that can provide a basis for improving health systems in every region of the country.
At the Foundation, we seek to address the current gaps in the medical decision-making system by promoting the understanding and adoption of informed medical decision-making, framing medical evidence in an unbiased manner that patients can access and understand, and sponsoring research to improve decision quality.