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Puzzling Evidence


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Puzzling Evidence

By Jock Hoffman, CRICO

Related to: Ambulatory, Clinical Guidelines, Primary Care, Other Specialties

The health care community is experiencing increasing tension between proponents of evidence-based decision making and dissent driven by provider habits and patient expectations. Exhibit A is any proposal to scale back cancer screenings: even those recommendations based on a preponderance of evidence now instantly face a barrage of counter proposals. Debates about annual mammograms for women under 50, routine PSA testing, and Pap tests are just the beginning. Physicians, especially in primary care, find themselves on the horns of a dilemma: amidst the uproar generated by political factions, medical societies, patient advocates, and conspiracy theorists, physicians may well wonder, “Whose advice do I follow?”



Decision Support from a Malpractice Insurer

Since 1995, CRICO has published and promoted decision support guides for managing patients through the screening and diagnostic process, initially for breast cancer, later for colorectal and prostate cancer. Along with representing three of the four most commonly occurring cancers, these (plus lung cancer) are those most commonly involved in failure to diagnose malpractice claims.

CRICO’s primary goal is to help primary care providers assess a patient’s risk status and need for screening, and to appropriately manage complaints or symptoms that may indicate the presence of cancer. In tandem with the risk assessment, the key components of CRICO’s decision support tools are:

  1. age and risk stratified screening and intervals between tests;
  2. recommended steps in response to complaints, symptoms, or abnormal test results;
  3. triggers for specialty referrals; and
  4. tips for test results management, coordination of care, and documentation.

To validate its advice for clinical practice, CRICO relies on accordance between clinical experts from Harvard-affiliated health care organizations, public agencies, professional societies (and their respective guidelines), and widely accepted research studies. CRICO’s process is designed to anchor recommendations in evidence that withstands time and scrutiny. Each decision support tool is reviewed every 18–24 months and revised (if necessary) in conjunction with new evidence and changes in health care delivery practices. In the interim periods, our expert panels review the literature to determine if they merit provisional communication with our insured physicians.

CRICO has found that experts from primary care and specialists who are committed to evidence-based practice develop recommendations that are credible and practical, especially those that frame the patient’s decision to undergo testing and those that guide the PCP’s decision to refer.

Additional Material

Are CRICO Decision Support Tools the Standard of Care?


June 28, 2012
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