1. About Effective Care


1.1: Effective Care

Effective care is a term used in the healthcare industry to describe healthcare strategies that have proven to be helpful for most patients with a certain condition most of the time. 

  • "Effective care refers to services that are of proven value and have no significant tradeoffs -- that is, the benefits of the services so far outweigh the risks that all patients with specific medical conditions should receive them." -The Dartmouth Atlas of Healthcare - (1.effective_care.pdf).
  • Effective care can save time and money for patients and help improve their quality of life. It can also save time and cost of ineffective treatments for the health care system when the most effective techniques or treatments are used.
  • Changes in the insurance reimbursement systems and government requirements have made it more difficult for physicians and other health professionals to spend as much time with patients as they might like due to increased time needed for recording data or coordinating care with insurance companies or with other health practitioners.
  • Effective care may refer to medical care or to other types of care that might be provided in a residential facility or in an education or sports center.
  • Some treatments or effective care practices may work better for some people or in some situations better than for others. Effective care strategies ideally include ways to assess whether a strategy is working for a specific individual instead of suggesting that a research average will produce average results for all individuals in all situations. Life is not average. An average is a math term.

1.2: Best Practice

Best practice is a term from the business world that is a similar to "Effective Care."

  • A definition of the term best practice by (1.businessdictionary.com) mentions that a "best practice" is also used as a benchmark - something to compare new strategies with to see if they are as helpful as the current best practices. 

"Best Practice: A method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark." 

The website (1.bestpractices.org) shares examples of a few corporations who have successfully established business practices that support the environment and reuse or reduce the company's use of natural resources while maintaining a profitable business.

1.3: Best Practices are developed by many experts trying things.

Learning from the experience and reliable research of others can help save time and lives and can be more cost effective than paying for the research for yourself or having to learn first hand during an accident or emergency. 

Recognizing that a risk may exist is necessary before you can realistically plan ahead and prevent it from happening or to be better protected from it. Experts are worth listening to because they have made many mistakes or at least tried a lot of strategies on their way to becoming expert in an industry. The beginner in any industry is likely to feel more confidence than an expert because the beginner is likely unaware of all the things that can go wrong while the expert may have experienced some mistakes first hand and heard about others from colleagues. 

Recognizing that a risk exists allows strategies to be developed to better cope with the risk or to help prevent the risk from occurring. Better tools can be designed and better checklists of which tools or equipment to bring along can be prepared by experts who have been out in the field and seen just what can go wrong and what generally works best.

1.4: Best Practices in Research

There are also best practices in research and in the use of statistical analysis of results. Math can be used to increase apparent significance of results and the results may not be able to be repeated by future studies or when the experimental procedure or treatment is attempted to be used in real world applications either in the business world or in medical practice with the treatment of patients.  

  • A discussion of variables in research and statistical analysis and how inaccuracy can affect policy decisions in dental practice is available here: Problems of correlations between explanatory variables in multiple regression analyses in the dental literature,  (1.4). 
  • A free/low cost university level course on understanding the statistics used in clinical research papers without focusing on the math itself is available online: (1.coursera.org/learn/clinical-research).
  • Or for those with less time, an article with tips for understanding the data analysis techniques used in research articles: (1.blogs.plos.org/absolutely-maybe).
  • Errors in research that is used to make government or corporate policy can result in increased costs as well as reduce effectiveness of the policy. Inaccuracy in research may result from how data is categorized and then use of the research can result in potentially life threatening and costly policy decisions, Errors Contained in Federal Reports Used for Health Policy and Funding Decisions, by Beth Waldron. (1.7)

See the page on Effective Research for more resources and information.

1.5: Are Best Practices in Healthcare Too Cost Effective?

Health care strategies that have consistently been shown to be effective by many clinical research studies may also become benchmarks that may be used as a comparison for the effectiveness of new research results. Unfortunately however best practices in the medical world don't always make it to the patient for their individual care and the reason is not cost - lack of profit might be more of the problem. 

  • "The Dartmouth Atlas Project has found that there is no correlation between higher spending and more widespread use of effective care. The causes of underuse include fragmented care (which tends to grow worse when more physicians are involved in the patient’s care) and the lack of systems to ensure that all eligible patients receive these treatments." - (1.dartmouthatlas.org).

Research regarding the use of effective care practices in the medical industry has found that more health spending is correlated with less use of the most effective care strategies. The problem may be associated with too many physicians and too many specialists being involved without adequate coordination between the group as a whole team. This may lead to recommendations or prescriptions being given by one specialist that may interact poorly with a prescription or treatment being given by another specialist, and an underlying problem may have been missed by both specialists because it wasn't within either of their areas of focus - a third specialist may have been needed.  (1.dartmouthatlas.org). 

  • More information is also available here: Americans Die Younger Despite Spending the Most on Health Care, (1.15)

Effective health care guidance regarding our need for clean air and the negative effects humans were having on the environment were noted as long ago as 1745 when John Armstrong published The Art of Preserving Health, a poetic essay on health. (1.14) Some of the health tips he includes in it are to avoid the "turbid" city air and avoiding closed, stuffy space by having “lofty” ceilings in order to have better air quality within the home:

YE who amid this feverish world would wear

A body free of pain, of cares a mind; (line 65)

Fly the rank city, shun its turbid air;

Breathe not the chaos of eternal smoke. 

. .

Let lofty cielings grace your ample rooms;

And still at azure noontide may your dome

At every window drink the liquid sky. (line 322) (1.14

Air pollution standards have improved since 1745, thanks to effective health care research and best practices of industry.

See the section 3. Patient Advocacy for more information about care coordination.

1.6: Research evaluation rating systems - benchmarks.

Returning to the topic of effective care as a benchmark or standard of comparison for other research, the U.S. Department of Health and Human Services (HHS) has an agency dedicated to reviewing medical research and summarizing results by levels of proven effectiveness. 

     The HHS Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program website, (1.effectivehealthcare.ahrq.gov), provides research summaries for consumers, clinicians and policymakers on medical topics or conditions that have already been reviewed and rated by the agency. (1.10) Comments can be submitted on topics under review by any concerned individual or organization and the information would be considered prior to the final rating or summary being published. 

  • One of the topics that is already published as a research summary is on alcohol use disorder and the medications that have been used in research trials for treating adults with the condition: Pharmacotherapy for Adults With Alcohol Use Disorder in Outpatient Settings, (1.11)    
  • Medications that did not have adequate peer reviewed published research available regarding their use for treating adults with alcohol use disorder were not included in the summary report. Medications that were reviewed are rated based on the strength of the research trials that were performed with that medication used as an experimental treatment. 

An evaluation rating scale is provided at the end of the US HHS, AHRQ Effective Health Care Program report. The categories they use for the Strength of Evidence Scale include: 

  1. "Strength of Evidence Scale High:
    High confidence that the evidence reflects the true effect. Further research is very unlikely to change our confidence in the estimate of effect." 
  2. "Moderate: Moderate confidence that the evidence reflects the true effect. Further research may change our confidence in the estimate of effect and may change the estimate."
  3. "Low: Low confidence that the evidence reflects the true effect. Further research is likely to change our confidence in the estimate of effect and is likely to change the estimate." 
  4. "Insufficient: Evidence is either unavailable or does not permit a conclusion."

  •  US HHS, AHRQ Effective Health Care Program:  (1.11)
  • This information is shared for educational purposes within the guidelines of fair use.

See the page on Effective Research for more information about research standards.

1.7: Effective care recommendations - best practices of health care.

  • Washing hands in between seeing patients was an effective care strategy that was clinically proven and used successfully to save lives in one physician's clinic in 1847 but which took twenty years before it was accepted and put into practice throughout the medical industry (Ignaz Semmelweis, 1.pbs.org). 
  • Effective care practices can help both patients and physicians and also the "providers" and the "payers," the health care system and the insurance or government agencies paying the bills. Adapting to change can mean embracing new technology and developing ways to incorporate it before being required to do so because the competition was willing. Read more: Internet of Things in clinical trials: Challenges, opportunities and the critical missing features to fully leverage the digital revolution, (1.knect365.com).
  • We have entered the Digital Information Age, even our medical devices and beds are getting informed about us and our preferences and problems. It is a golden age for learning for us too, not just for our digitally connected Internet of Things. It is also a renaissance of free education for all ages and learning styles, with a wide variety of material available online for anyone with an internet connection. There is no need for medical breakthroughs to take twenty years to reach patients or to reach individuals before they become patients. Preventative health education can save lives and save dollars and save tears of grief or pain. 
  • Preventative health education can be a do-it-yourself project but it can also be helpful to have a guide or a team of guides to help lead the way to more reliable resources and to check your progress along the way. Your healthcare team is your primary guide, however patient advocates and care coordinators can help when things get complex. But the self care of preventative health care is, in itself, a do-it-yourself project. Health insurance or a prescription pad can't take the walk for you, or prepare the extra meals in advance so they are ready for the days when there's no time to spare.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. 
  • The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert

Continue reading: 2. Effective Care Resources

Instinct & Policy; Resources

Table of Contents

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  • Chapters and Glossary section summaries & links, and a link for the book version of this site, Instinct & Policy: Effective Care and Best Practices for Promoting Health and Preventing Harassment and Discrimination. 

Table of Contents

1. Links & References

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Links and Reference footnotes for

 Chapter 1: About Effective Care.

1. Links & References.pdf

Glossary & Resources

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  • Definitions of terms and the resources & therapy techniques from the various sections gathered in one location for convenience with some additional topics and material for background detail not covered elsewhere. 

Glossary & Resources