Arnold Kling  

A Health Care Experiment

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Called the Medicare Coordinated Care Demonstration


Coordinated care services are actions taken by a Registered Nurse (RN) Care Manager to help your doctor(s) determine your care. The RN Care Manager will also check on you at regular times and help set up the care you need. The RN Care Manager will help with sharing facts about your health care and needs with your doctor(s). This study is paid for by the Centers for Medicare and Medicaid Services...

This study will assign patients by chance...to two groups. One group will get the extra services explained above...


The goal is to "increase [patients'] understanding of the care planned for them. It may also help cut hospital stays and improve the quality of their lives."

My father signed up to participate as a patient in this study. I like the fact that (a) Medicare is looking into ways to better coordinate care and (b) they are evaluating the alternative using a rigorous controlled experiment.

It appears, however, that my father was assigned to the control group--the group that does not get the experimental RN Care Manager. We've been dealing with the existing system.

I have hopes that my father will rehabilitate under the existing system, but I would feel vindicated if in this experiment the treatment group has benefits that exceed the costs to an extent that is statistically significant.


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COMMENTS (5 to date)
Michelle writes:

I also think that this is a good idea. If there is any way that could possibly improve the health care system, then we should go for it. If this research could possibly reduce medical costs, then more people may be willing to seek medical help when they get sick or hurt. If someone cuts his hand, and he needs to go to the emergency room, he will may be more likely not to go if he knows that it is going to cost him a fortune to go. Even though this plan may decrease medical costs, it doesn't mean that it will reduce the profits that the company has. If more people will be willing to go to the doctors, the office will be bringing additional revenue and possibly even repeat customers. One of the biggest costs for businesses is trying to gain new customers. It is cheaper for a business to keep previous customers. I think that this program will increase the demand for medical assistance.

The article also states that this could maybe improve a person's quality of living. This would be kind of like an economic cost because it isn't something that can be valued in terms of money. The extra time that a patient is feeling better can't be valued with money. It will also make patients feel better because they will feel as if they know what is going on.

Dr. T writes:

Mr. Kling: If your father is truly in the control group, then this study is badly designed. In a study comparing a new intervention to existing care, the patients randomized to receive existing care should be told nothing. This study design is appalling because it raises false hopes and adversely affects the control patients (because they may get angry, frustrated, disappointed, depressed, etc. about not receiving the extra services). I, too, am glad that Medicare is investigating better ways to deliver health care, but this study's design makes me angry.

Arnold Kling writes:

My father does not know to which group he was assigned. But it's obvious that no nurse is talking to him about the plan for his care.

I don't see any way that this experiment could be done with informed consent and still be "blind."

Zach writes:

I agree with the previous poster, the design of this study allows for a number of confounding factors to creep in and potentially skew results (the saddened, angry, etc. patient will do poorly relative to the patient that 'wins' and gets extra care/time/input from a nurse).

In response to Kling, the study could have been 'blinded' by:
#1. The IRB waiving the need for informed consent. If the care they are receiving is what they would have received while not in the study, why do they need to be consented? Or,
#2. Having a 'Nurse Coordinator' or someone acting the role, meet with the control patients, but do nothing to coordinate the care (i.e. - someone plays the nurse and sits with the patient and acts understanding, but provides no input to the real medical team that would alter the course of care. That way you eliminate the knowledge of treatment vs. control causing confounding bias, and you eliminate the variable of 'someone taking an interest in me and listening to what I have to say' as a placebo effect of the nurse manager.

While not perfect, it's an interesting study.

bt writes:

Caring and worrying for parents while they undergo treatment is not easy. I can appreciate what you are going through, as my mom underwent cancer treatment recently. Good Luck.

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