Thursday, September 27, 2007

Defaults suggested to improve healthcare outcomes

In today's NEJM (, Halpern, Ubel, and Asch describe the use of defaults to improve utilization of evidence-based practices. This strategy, which requires that we give up our status quo and omission biases ( ), could prove highly useful - if we have the gumption to follow their good advice and adopt it.

It is known that patients recieve only approximately 50% of the evidence-based therapies that are indicated in their care (see McGlynn et al: and that there is a lag of approximately 17 years between substantial evidence of benefit of a therapy and its adoption into routine care.

Given this dismal state of affairs, it seems that the biggest risk is not that a patient is going to receive a defalut therapy that is harmful, wasteful, or not indicated, but rather that patients are going to continue to receive inadequate and incomplete care. The time to institute defaults into practice is now.

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