Effective care refers to services that are of proven value and have no significant tradeoffs -- that is, the benefits of the services so far outweigh the risks that all patients with specific medical needs should receive them. These services, such as beta-blockers for heart attack patients, are backed by well-articulated medical theory and strong evidence of efficacy, determined by clinical trials or valid cohort studies. Failure to provide effective care can lead to serious consequences; for example, amputation of a leg is an infrequent but devastating complication of peripheral vascular disease and diabetes.
The claims-based analyses of effective care focus on either the entire fee-for-service Medicare population eligible for both Part A and B and between the ages of 65 and 99 or a subset of that population at risk for a specific procedure or service. For example, the analysis of amputations examines the entire Medicare population, while the analyses of testing among diabetics are restricted to Medicare beneficiaries between the ages of 65 and 75 with a diagnosis of diabetes. When appropriate, statistical adjustments are carried out to account for differences in age, race and sex.