The Best Practices Innovation Collaborative is focused on addressing the substantial shortfalls in the delivery of proven interventions in health care practice. Participants with relevant expertise will collaborate on a project that will initially identify cases in which evidence is underapplied and will analyze the health and economic effects. Details on the approach and timetable can be found in the attached document. 
 
Issue: 
A learning healthcare system is one in which interventions with demonstrated value are rapidly and fully adopted into practice. However, recent studies have found substantial shortfalls and inconsistencies in the delivery of proven interventions. The health and economic consequences of opportunities missed at this level represent serious and unnecessary inefficiencies in the nation’s healthcare delivery system

• On average clinicians provide evidence-based care—or best practices—only half of the time.
• Sometimes the shortfalls in care relate to failure to follow recommended protocols, such as hemoglobin A1c monitoring in diabetes
• Patients may receive a smaller range of services than would be suggested by the evidence.
• Schizophrenic patients are more likely to die of heart disease, but cardiovascular services might be beyond what is currently provided by the public mental health system.

Estimating the potential health and economic impact of full delivery of certain recommended services will begin to place the importance of the services into an appropriate context, clarify the ways barriers obstruct the delivery process, and draw attention and emphasis to efforts to address those barriers.
 
Project:
This project will:

• identify a number of interventions that represent evidence underapplied (the “use cases”)
• seek to analyze the health and economic implications if best practices with optimal application prevailed

Roundtable members whose organizations have particular expertise and interests in the use case areas will lead the conduct of the initial analyses, which will then be reviewed and prepared in final for discussion at an IOM meeting to be held September 30, 2008 to explore strategies to improve application of evidence. Diseases suggested as good examples of prevalent conditions, with well defined but underapplied interventions and reasonable initial analyses of potential impact include asthma, diabetes, heart disease, and schizophrenia.