Understanding and improving value frameworks with real-world patient outcomes.

Objectives: To provide recommendations that will improve approaches to measuring the value of new medical technologies to patients.

Study Design: Informed discussion by experts after literature review.

Methods: A working group was formed, and participants discussed how value frameworks should incorporate key features important to patients in evaluating new medical technologies, particularly for chronic diseases.

The social value of childhood vaccination in the United States.

Objectives: To determine the lifetime social value of using the guideline-recommended vaccines for children born in the United States in 2009.

Study Design: This study utilized an economic model with parameter values sourced from clinical and observational data, as well as the literature.

Methods: The model quantified the health effects of routine vaccination for 14 diseases in terms of quality-adjusted life-years (QALYs) saved.

Ways decision makers can use evidence to improve patient outcomes in learning health systems: a message from the guest editor.

A learning health system is one in which clinical information and research are continually used to improve the processes, outcomes, and quality of care. No matter which definition of comparative effectiveness research (CER) or patient-centered outcomes research (PCOR) is preferred, there is nearly universal agreement that a core feature of these research efforts is the need to engage decision makers, such as patients, providers, and policymakers, in prioritizing and defining research that addresses and resolves important evidence gaps to improve patient care and outcomes. In this set of eGEMs papers focused on decision-making, leaders in scientific fields with an interest in developing the next generation of CER, PCOR, and quality improvement (QI) studies share their perspectives on the potential applications, as well as the short-and longterm challenges, of using electronic clinical data (ECD) to address health care information needs within a learning health system.

Translating medical effectiveness research into policy: lessons from the California Health Benefits Review Program.

Context: Legislatures and executive branch agencies in the United States and other nations are increasingly using reviews of the medical literature to inform health policy decisions. To clarify these efforts to give policymakers evidence of medical effectiveness, this article discusses the California Health Benefits Review Program (CHBRP). This program, based at the University of California, analyzes the medical effectiveness of health insurance benefit mandate bills for the California legislature, as well as their impact on cost and public health.

Litigating the science of breast cancer treatment.

Beginning in the late 1980s, many health insurers refused to cover high-dose chemotherapy with autologous bone marrow transplant (HDC/ABMT) for high-risk and metastatic breast cancer patients. Insurers denied coverage because there was no persuasive evidence of clinical effectiveness. In response, many women sued to compel coverage.

Evaluating medical effectiveness for the california health benefits review program.

An important aspect of the mandate assessments requested by the California legislature is a review of the scientific and medical literature on the medical effectiveness of the proposed health insurance benefit mandate. Although such a review bears many similarities to effectiveness reviews that might be undertaken for publication as research studies, several important differences arise from the requirements of the California legislation. Our reviews are intended to assist the legislators in deciding whether to support a specific mandate to modify health insurance benefits in a particular way.

Independent medical review of health plan coverage denials: early trends.

Concerns among patients and physicians that health plans would deny coverage for medically necessary services has brought about legislation mandating independent medical review (IMR) of denied services. Among 1,400 cases submitted in California, the most common areas for dispute were cancer care, endocrine/metabolic care (especially for obesity), orthopedic care, and neurological disorders. Surgery and pharmacy services constituted 52 percent of cases.