Evidence-based health care
from the consumer’s point of view
Presented by:
Kristin L. Carman, Ph.D.
Presented to:
Academy for Health Services Research Annual Meeting, Orlando, FL, June 2007
Project team and funding
 American Institutes for Research
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 Kristin L. Carman, PhD, Project Director
 Pamela Dardess
 Christine Whitmore, PhD
 Carolyn Vance
McGee & Evers Consulting, Inc.
 Jeanne McGee, PhD
 Mark Evers, PhD
Funding
 California Health Care Foundation
Purpose of our project
 To develop a Communication Toolkit – “Explaining
evidence-based health care to your workforce”
 To build the Toolkit, assess and understand:
 What are employers and unions doing to communicate
on this topic
 What are desired topics and components of the
Toolkit
 What are consumers’ understanding of different
components of EBHC
Methods and data

Environmental scan
 Literature review
 Review of websites
 10 phone interviews with experts

15 Key stakeholder interviews with information
intermediaries representing unions and employees
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4 Focus groups (2 union groups, 2 non-union groups)
Cognitive Interviews (Round 1 completed)
Future activities include:
 4 additional rounds of cognitive testing of materials
 Survey of consumer attitudes about evidence-based concepts
(sponsored by the NBGH)
Findings to date – five themes
 Comprehension
 Relevance
 Overload
 Trust
 Discomfort
THEME # 1 - Comprehension
Consumers struggle to
figure out what is meant by
“evidence-based medicine”
Where does evidence
come from?
What are
“guidelines” or
“best practices”?
Who decides
what is “good”
evidence?
Who decides when
and how guidelines
should be applied?
Reactions we got from consumers
 “it’s nothing new”
 [evidence?] “my doctor tries different
things on me until he finds what works.”
 “it could be harmful”
 “it could be biased”
 “it sounds like ‘one size fits all’ and that
could get in the way of medical judgment”
It’s often counter-intuitive
 When people believe that “more care is
“better care,” or that it’s hard to
accept any evidence that says otherwise
 When people believe that “good quality
costs more,” it’s hard to accept
evidence that good quality can
sometimes cost less
 When people believe they are unique,
it’s hard to accept uniform standards
for care
THEME # 2 – Relevance
Consumers may question what
evidence-based medicine means
for them personally
Reactions we heard from consumers
 People tend to trust their own judgment
about “quality” of medical care
 Even when they acknowledge possible
problems with quality, they think their
doctor or care is great
 When medical evidence or guidelines are
invoked, some think it second guesses
their doctor’s good judgment
THEME # 3 - Trust
Consumers tend to be
suspicious of employer’s
motives in moving toward
evidence-based approaches
Basic lack of understanding
 Consumers lack awareness and
knowledge of how employers and
insurance companies are involved in
benefit design and the financial side of
health care
 It’s hard for consumers to appreciate
the broader context that impels changes
Distress about rising costs and changes
to health care benefits
 Consumers are distressed and distrustful,
especially when cutbacks in benefits are
coupled with higher costs
 Consumers get frustrated about new layers of
control over what kinds of care are covered,
how and where they can get care, and what
they have to pay
 Consumers often feel that employers are more
concerned with the bottom line than with
employees’ health
With evidence-based changes to
benefits design, distrust can be worse
 Hard for consumers to understand how
employers might use medical evidence to
guide changes to benefits and how the
changes might be helpful to consumers
 Consumers may feel that their employer
is getting into an area where they don’t
belong
The irony: trying to empower
consumers can have the opposite
effect
 Frustration that employers are making
changes, taking away options, and shifting
responsibility to employees
 Rather than feeling more empowered
about their health, consumers can feel
that they are losing control
THEME # 4 – Discomfort
Being urged to be better
informed and more assertive
about their health care puts
pressure on consumers
It’s hard to challenge the traditional
doctor-patient relationship
 Patients are used to relying heavily on
their doctors and they can feel
vulnerable
 It can be hard to ask questions, let alone
challenge what the doctor advises
 Knowing that quality of care can vary a
lot is not welcome news if patients feel
unable or unwilling to act upon it
THEME # 5 - Overload
Consumers already feel
overwhelmed with information
and short on time.
Needing to understand and
deal with medical evidence
adds to the overload.
For more information, contact:
Kristin L. Carman, PhD
Principal Research Scientist
American Institutes for Research
1050 Thomas Jefferson St., NW
Washington, DC 20007
202-403-5090
Kcarman@air.org
www.air.org