Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

Anytime you get news from your doctor, you'll likely have three immediate questions: what does this mean, what should I do about it, and how will this affect my life? Quality health care uses the best available science to help you answer those questions.

Say you're a 55-year-old woman and your doctor tells you that a test shows your bones are getting thinner, known as decreased bone density. Your doctor will give you all sorts of treatment options. Should you take drugs? Start taking vitamin D and calcium? Begin an exercise program? Or just watch and wait?

Because health care can be so varied and so personal, you always have choices. But the seemingly straightforward question—"What's the best option for me?"—can be a very difficult question to answer. In health care, one size does not fit all, and treatments that are good for one patient aren't necessarily good, or even safe, for you.

It would be nice if the best option for each individual patient were always clear-cut, but the truth is it often is not. That's why we have a kind of scientific research called comparative effectiveness. This kind of research, or evidence, compares how the different treatments for specific conditions have worked for others. It can also help you and your doctor make the best decisions for you.

If you're the woman with thinning bones, you might have osteoporosis—but not necessarily. There are effective medicines you could take, but there is limited information about how they work over the long term. You could take calcium, but some women develop kidney stones when they do. Exercise is always good, but there are no precise guidelines on how much you should increase your physical activity. Many women with low bone density never break a bone, so watching and waiting may be a good option.

How do you decide what to do?

This is the kind of help that comparative effectiveness research can provide. It's the kind of research that directly helps patients. (In fact, research on thinning bones has already been published in a consumer guide, which may be appropriate if you've been diagnosed with osteoporosis.)

The good news is that we're about to do much more comparative effectiveness research.

This type of research has been in the news a lot lately. My agency, the Agency for Health Care Research and Quality (AHRQ), has been heading up comparative effectiveness research for a long time through its Effective Health Care program. Now, the Federal Government is stepping up funding for this research. The American Recovery and Reinvestment Act of 2009, also known as the stimulus package, contains a big investment into comparative effectiveness research.

Why is this research so important?

Because good information is the key to good health care. Did you know that once a new piece of scientific evidence emerges as a medical advance, it takes up to 17 years before doctors routinely incorporate that information into how they practice medicine?

One of the reasons health care quality varies so much is that sometimes doctors or nurses just don't know or follow the latest research. And, even when they do keep up, often through extensive effort, it is usually not possible to find valid information that applies to the question at hand. Modern medicine is highly advanced, but the science does you no good if you don't get the right advice from your doctor or other health care professionals.

It's also important to keep in mind what comparative effectiveness doesn't do. It does not make policy or health care decisions for you. It does not tell your doctor how to practice medicine. And it does not make decisions about what kind of treatments your insurer will pay for.

Instead, comparative effectiveness research will help you and your doctor determine what you should do to treat or manage an illness. Medicine is performed best when doctors and patients together make choices based on the best available information. That's what comparative effectiveness research does: it weighs the evidence to help guide your decisions and presents that information to you and your doctors in a way you can use.

If you've recently been diagnosed with a disease or condition, please visit AHRQ's Effective Health Care program's consumer guides page to see if we've published information that can help.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

Agency for Healthcare Research and Quality
Effective Health Care
Comparative Effectiveness Definition
http://effectivehealthcare.ahrq.gov/index.cfm/glossary-of-terms/?pageaction=showterm&termid=118

Agency for Healthcare Research and Quality
Effective Health Care
Osteoporosis Treatments That Help Prevent Broken Bones: A Guide for Women After Menopause
http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg&DocID=92&ProcessID=8

Agency for Healthcare Research and Quality
Effective Health Care
Summary Guides
http://effectivehealthcare.ahrq.gov/healthInfo.cfm?infotype=sg#subListconsumer

Page last reviewed April 2009
Internet Citation: Comparative Effectiveness Research: What It Means for You. April 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/040709.html