All too often, at Duke and other hospitals, he says, these decisions have been made on an ad hoc basis, "with different people involved each time, and each time reinventing the wheel. It was increasingly apparent this was not the best way to do it, but we lacked the structure and rigor for a procedure for how" to make these decisions.
The 10 "accountability for reasonableness" steps are outlined in the Archives of Internal Medicine. They are as follows:
1. The policy must be transparent and open to anyone for review.
2. It must be relevant to the population of patients and healthcare providers affected by its application.
3. There must be a system by which people can appeal a decision they think is wrong.
4. The institution that has the policy must implement it and assure that everyone follows the rules
5. The allocation of the drug must be fair, in that clinically similar patients are always treated similarly, "with no 'special' people, physicians, or patients" receiving exceptional consideration.