Evidence Development & Decision Science

The systematic production and application of medical knowledge to clinical practice. LDI Senior Fellows analyze the process by which data affect coverage and clinical decisions, and conducts comparative effectiveness and cost effectiveness studies.

43 Ways to Leave Your Technology

Feb. 14, 2017

We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.

False Dichotomies and Health Policy Research Designs: Randomized Trials Are Not Always the Answer

Dec. 31, 2016

Stephen B. Soumerai, Rachel Ceccarelli, and Ross Koppel

In the Journal of General Internal Medicine, Stephen Soumerai and colleagues, including LDI Senior Fellow Ross Koppel, highlight the benefits of using quasi-experimental designs and observational data when a study neither permits or requires a randomized controlled trial (RCT). Using Campbell and Stanley’s classic research design monograph, which classifies research as randomized experiments, strong quasi-experiments, and weak pre-experiments, the authors provide a simple hierarchy of common strong and weak designs, with RCTs and interrupted time series (ITS) both classified as...

Attitudes and Practices of Euthanasia and Physician Assisted Suicide in the US, Canada and Europe

Aug. 19, 2016

Ezekiel J. Emanuel; Bregje D. Onwuteaka-Philipsen; John W. Urwin; Joachim Cohen

In JAMA, Ezekiel Emanuel and colleagues review the legal status as well as the available data and practices of euthanasia and physician assisted suicide. This study gathers data from polling, published surveys of the public and physicians, official state and country databases, interview studies with physicians and death certificate studies from 1947 to 2016 to paint a thorough picture. The findings show that euthanasia and physician-assisted suicide can be practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada. Physician assisted suicide, excluding euthanasia, is...

A nudge toward participation: improving clinical trial enrollment with behavioral economics

Aug. 15, 2016

Eric M. VanEpps, Kevin G. Volpp, Scott D. Halpern

In Science Translational Medicine, Eric VanEpps, Kevin Volpp and Scott Halpern suggest behaviorally informed interventions, or “nudges” that might be tested and implemented to improve patient recruitment and enrollment in randomized controlled trials (RCTs). Participant recruitment represents one of the largest costs of conducting RCTs, and barriers to recruitment can generate problems of selective enrollment and under-enrollment. The authors present a taxonomy of different approaches aimed at increasing clinical trial enrollment, based on behavioral economics principles. The...

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