In the previous lesson, we talked about the high cost and waste as opportunities for improving the US health care system. Yet for all this money we're paying, the next question is do we get as good of health care as we would expect from known best practices or scientific evidence? Do we get high quality of care that is based on known evidence? This is sometimes called the knowing versus doing gap or the difference between what care is based on scientific evidence and what care is actually delivered. In this lesson, we will attempt to address and answer these questions. As a result, you will be able to compare some of what is known about providing scientific care and what patients actually receive. A classic 2003 study published in The New England Journal of Medicine found that overall participants received about half of the scientifically recommended processes involved in care. More specifically, 61 percent of patients with a myocardial infarction or heart attack and who were appropriate candidates for aspirin, received aspirin therapy. So, that would mean that 39 percent of patients who should have gotten an aspirin, did not get it. Yet the evidence shows that aspirin can reduce the risk of non-fatal myocardial infarction by 30 percent, and can reduce the risk of non-fatal stroke by 40 percent. So, something as inexpensive as aspirin. If you just give it to the appropriate patients, can lead to a major decrease in heart attacks and strokes. Another example among elderly participants, only 64 percent had received or had been offered a pneumococcal vaccine. However, research shows that nearly 10,000 deaths from pneumonia could have been prevented each year by simply giving this vaccine, but only 64 percent of the elderly participants get it and obviously, if you're elderly, you're at a higher risk of from pneumonia and higher risk for death from pneumonia. Finally, as a last example, only 36 percent of patients had been screened for colorectal cancer. Some research suggests that this very inexpensive blood tests could save about 9,600 deaths per year. This graphic shows additional examples related to preventive, acute, and chronic care. As you can see, only a relatively small percent generally get the recommended care. In the US, a huge percent of our gross domestic product goes to medical care, but we're often not getting good care. Why does the knowledge about the best way to care for someone who is ill is often not used? One explanation involves a sheer volume of new biomedical discoveries. It can't be absorbed by the average person. Thus the US health care system is characterized by more to do, more to know, and more to manage than any other time in history. To quantify this increase, consider the volume of the biomedical and clinical knowledge base that is rapidly expanded with research publications having risen from more than 200,000 per year in 1970, to more than 750,000 a year in the year 2010. As a result, if you're a neurologist, and you're trying to do the best you can, and keeping up with these discoveries, and the best way to care for your patients, how in the world can you read all these journals or learn all the thing that's been discovered in one year alone? We have a knowledge paradox or what I've been calling a Knowing Doing Gap. Advances in science and technology have improved the ability of the health system to treat disease. We know more how to do things better, yet the sheer volume of these discoveries stress the capabilities of both the system, certainly in individuals to effectively generate, and manage knowledge, and apply it to a regular care. So, one of the results of this massive amount of knowledge that's added every year is that it simply takes too long for those clinical discoveries to impact health care. We know from historical research and from a large body of studies called the diffusion of innovation research that people are often slow to adopt new technologies. Even if the technology later turns out to be safe and helpful. Part of this is related to the fact that many innovations are complex and might be associated with risks or costs among potential adopters, yet some simple innovations can be stalled by cultural or political forces. Consider French clinicians practicing medicine in about the year 1820. It took them 200 years after the discovery of thermometers to adopt them in their practice. Thus, even in the 16th hundreds, clinical innovation occurred the thermometer, but it took several 100 years for the physicians to actually start using them. Sadly, slow diffusion of innovations is common today. It is nearly universally understood that there is often a gap between scientific knowledge about the best way to treat a patient and how a patient is actually treated. Clinical research findings and clinical practice guidelines that are promised to improve health, move very slowly from research settings into clinical practice and many of these interventions never reach those who could benefit. It's been estimated that it takes on average 17 years to translate the only 14 percent of original research into benefit for patients, and an average of nine years for interventions recommended as evidence-based practices to be fully adopted. We know how to give better care, but it takes nine to 17 years for a fraction of that care, only 14 percent to actually be used and have an impact on the average person getting care. They are critical changes that make it important to implement the most effective and cost effective treatments. In America and other developing countries, we have a demographics problem. First, we have a diverse population, and the diversity of our population means that we have different hereditary diseases among our large population. Next, we have an aging population and clearly, if you're older, you need more healthcare. According to the US Census Bureau, there are more than 77 million baby boomers in the country and by the year 2030, this demographic who are born between 1946 and 1964 will represent an estimated 20 percent of the population. Next, if you are poor and can't afford health care, you're more likely to experience poor clinical outcomes and even a lower life expectancy. For example, if you don't have health insurance and you put off going to the doctor until you just can't live without it anymore and then you show up at the emergency room, your cost will be a lot more. More importantly, you will not get the best outcome because you should have been treated in a primary setting all along. Overall, we have different needs and different cultures that impact how people view physicians, medication, and hospitalization. In addition, the US, with its high cost of care, and inefficient, and poor clinical outcomes, is going to have to absorb this growth based on the aging population. A growing group of older and likely sicker people to care for relates to our next topic related to novel approaches to manage these patients.
