Simon Chuang

LePore
2 June 2014
Genetics 9: Period 3
Fixing Whats Broken: OHSUs Role in Health Reform and Evidence-based Medicine Notes
1. Evidence-based Medicine by Robert Chou

Name Evidence-based Practice Center was originally designated to centers with

expertise in conducting systematic review.

Oregon center was founded in 1997

Oregon center is regional with support from OHSU, UW, and other universities and
organizations.

EPCs (Evidence-based Practice Centers) perform US Preventative Services Task Force,

Oregon drug class, National Institutes of Health, and National Pain Society reviews.

In 2000, more Randomized Control Trials were performed than all of 1965-1975.

EPCs have the goal of being systematic to remove bias in medical literature.

In the US, over $100 billion dollars are spent on LBP (Lower Back Pain).

LBP is the most common reason for reduced productivity.

Two back-pain-related procedures, lumbar fusion (costs $40,000-$70,000) and lumbar

spine imaging increased 3 times and 4 times, respectively, in 10 years.

In 1992, the 4% lower LBP statistic rose to 10% in 2006 averaged across all ages.

No magic cure for LBP exists, and the main treatments include self-care, medications,
and surgical interventions.

Imaging (MRI, etc.) is not necessary for LBP.

The main surgery, spinal fusion (which the instances of doubled in 1997-2009) is a bone
graft to promote fusion or instrumentation such as pins.

rhBMP-2, a drug, stimulates bone production and accelerated fusion, and was FDA
approved in 2002.

rhBMP-2 use went from 0.7% in 2002 to 30-50% in 2007, and most use was off-label.

Most studies on the side effects and effectiveness of rhBMP-2 were sponsored by
Medtronic, the company it was developed by.

New studies were conducted and the data was put in the Yale Open Access Data project,
allowing anybody to see it.

Reviews of this data conducted at EPCs showed no significant bone growth increase and
found rhBMP-2 caused cancers and malignant bone growth.

Reviews also showed that industry-sponsored studies omitted negative results, didnt
define key terms used in the overall finding, and passed off the same data as multiple
studies.

2. Health Reform by John McConnell

Health Care costs consist of 2/3 new technology costs and 1/3 aging costs.

The Affordable Care Act (ACA) expands medical coverage, lowers private premiums,
adds employer health care requirements, and guarantees health coverage.

System of cost control established under the ACA gives reduced payments for excess
readmissions and established the Independent Payment Advisory Board.

In Oregon, Coordinated Care Organizations (CCOs) have more accountability, integrate

physical, mental, and dental care, and answer to a global budget.

The global budget has a fixed increase over time and moves away from Fee for Service
(FFS), gives flexibility in non-strictly-medical costs (including preventative measures).

Oregon Health Authority established incentives for CCOs in quality of care.

CCOs provide hospital to home care and outreach for self-care.

The Medical Respite program exists for homeless patients who need follow up care
(wounds that need to be kept clean, etc.).