Improving Brain Health Outcomes with Tech, Incentives and Comparative Effectiveness Research

Mal­prac­tice Method­ol­o­gy (New York Times OpEd by Peter Orszag)

Right now, health care is more evi­dence-free than you might think. And even where evi­dence-based clin­i­cal guide­lines exist, research sug­gests that doc­tors fol­low them only about half of the time. One esti­mate sug­gests that it takes 17 years on aver­age to incor­po­rate new research find­ings into wide­spread prac­tice. As a result, any clin­i­cal guide­lines that exist often have lim­it­ed impact. How might we encour­age doc­tors to adopt new evi­dence more quickly?

If this is the case with health care over­all, despite much progress over the last 30–40 years, imag­ine how worse it may be when we talk about brain health, when neu­ro­science and cog­ni­tive neu­ro­science are rel­a­tive­ly more recent disciplines.

This is a key insight to keep in mind as we debate the val­ue and lim­i­ta­tions of inno­v­a­tive brain health solu­tions, espe­cial­ly those that are non-inva­sive and have no neg­a­tive side effects:  what mat­ters most to actu­al human beings liv­ing today is how those tools and solu­tions seem to per­form, based on best evi­dence, com­pared to alter­na­tives avail­able today — not com­pared to Pla­ton­ic ideals about research and prac­tice which may exist in our minds but not in the real, empir­i­cal world. Of course we then need to guide research so that we have bet­ter evi­dence in the future, but progress must occur in par­al­lel and rein­force each oth­er: progress in prac­tice and in research.

The OpEd author then pro­ceeds to defend mal­prac­tice reform as the pri­ma­ry way to do so. This may well be so with health­care as a whole, but when we are talk­ing about brain care I believe his next 2 pro­pos­als are more direct­ly relevant:

Bet­ter tech­nol­o­gy would help, too. Your doctor’s com­put­er should be able to not only pull up your health records (after you have approved such access) but also quick­ly sug­gest best-prac­tice meth­ods of treat­ment. The doc­tor should then be able to click through to read the sup­port­ing research. Sub­si­dies in the stim­u­lus act help doc­tors pay for this kind of technology.

A final step toward improv­ing stan­dard med­ical prac­tice will be to bet­ter align finan­cial incen­tives for deliv­er­ing high­er-qual­i­ty care. Hos­pi­tals now lose Medicare dol­lars, for exam­ple, if they suc­ceed in reduc­ing read­mis­sions. Med­ical pro­fes­sion­als should be giv­en incen­tives for bet­ter care rather than more care.

A cou­ple of recent inter­views in our expert series elab­o­rate on these points, show­cas­ing how inno­va­tion is already tak­ing place:

• “…putting good evi­dence to work in prac­tice requires more than pub­lish­ing good research. I’d say that sci­en­tific evi­dence is direct­ly rel­e­vant to per­haps 15% of clin­i­cal deci­sions…we require tech­nolo­gies that trans­late emer­gent knowl­edge into prac­tice.” — Dr. John Docher­ty, Adjunct Pro­fes­sor of Psy­chi­a­try at Weill Med­ical Col­lege, and for­mer Branch Chief at NIMH. Full Inter­view Notes.
• “We should be think­ing about the brain through its whole life­time…We need to break the silos, to aggre­gate knowl­edge, to help advance our knowl­edge of the brain 50 years in 5 years.” — Patrick Dono­hue, founder of the Sarah Jane Brain Project. Full Inter­view Notes.

Enabling and accel­er­at­ing such inno­va­tion is of course why we are launch­ing the Sharp­Brains Coun­cil for Brain Fit­ness Inno­va­tion.