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cost effectiveness; high-value care; cost-conscious care

Also see patient safety Management: - evaluate the benefits, harms & costs of interventions - eliminate use of interventions that provide no benefit &/or may be harmful - choose interventions & care settings that maximize benefits, minmize harms & reduce costs using evidence-based medicine - establish a plan that incorporates the patient's wishes & concerns - identify system level opportunities to improve outcomes, minimize harms & reduce costs (waste) - capitation vs fee-for-service may diminish incentive for unnecessary tests & procedures - includes no CBC or electrocardiogram prior to elective hernia repair - Choosing wisely in adult hospital medicine [17] - reduce use of opioids (4.57)* - improve sleep (4.52)* - minimize overuse of oxygen (4.52)* - reduce serum CK-MB use (4.50)* - appropriate venous thromboembolism prophylaxis (4.43)* - decrease daily chest x-rays (4.43)* * score on a 5 point system [17] Notes: - diagnoses derived from administrative data do not distinguish appropriate from inappropriate emergency department visits [3] - malpractice reform alone will not reduce the cost the use of high-cost medical imaging in the emergency department [3] - low-value imaging is associated significantly with owning imaging equipment [12] - little correlation between higher spending & higher quality of care [14] - nearly 30% of health care costs are spent on unnecessary tests & treatments [10] - ordering unnecessary diagnostic testing does not alleviate patient fears & concerns [10] - a daily reminder to decrease lab testing can significantlu lower ordering of unnecessary predischarge blood tests [15] - treatment decisions are not entirely driven based on a physician's knowledge or judgment, they are also driven by what payers are willing to pay for [13] - case made for payer role in opioid crisis, through denial of payment for newer, more expensive less-addictive opioids [13]

Related

continuous quality improvement (CQI) or total quality management (TQM) opportunities to improve quality & cost-effectiveness of health-care patient safety

References

  1. Langer-Gould AM et al. The American Academy of Neurology's Top Five Choosing Wisely recommendations. Neurology 2013 Feb 20; PMID: 23430685 http://www.neurology.org/content/early/2013/02/20/WNL.0b013e31828aab14
  2. Choosing Wisely. An Initiative of the ABIM Foundation http://www.choosingwisely.org/doctor-patient-lists/ - Five Things Physicians and Patients Should Question (5 items from each of 17 societies) = 85 items http://www.choosingwisely.org http://www.choosingwisely.org/wp-content/uploads/2013/02/Choosing-Wisely-Master-List.pdf
  3. Raven MC et al. Comparison of presenting complaint vs discharge diagnosis for identifying "nonemergency" emergency department visits. JAMA 2013 Mar 20; 309:1145. PMID: 23512061
  4. Waxman DA et al. The effect of malpractice reform on emergency department care. N Engl J Med 2014 Oct 16; 371:1518 PMID: 25317871
  5. Agency for Healthcare Research and Quality Public Reporting of Cost Measures in Health. Technical Brief - Final - Mar. 5, 2015 http://www.effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2053
  6. Qaseem A, Alguire P, Dallas P et al Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Ann Intern Med. 2012 Jan 17;156(2):147-9. PMID: 22250146
  7. Yazdany J, Schmajuk G, Robbins M Choosing wisely: the American College of Rheumatology's Top 5 list of things physicians and patients should question. Arthritis Care Res (Hoboken). 2013 Mar;65(3):329-39 PMID: 23436818
  8. Rosenberg A, Agiro A, Gottlieb M et al Early Trends Among Seven Recommendations From the Choosing Wisely Campaign. JAMA Intern Med. Published online October 12, 2015 PMID: 26457643 http://archinte.jamanetwork.com/article.aspx?articleid=2457401 - Gonzales R, Cattamanchi A. Changing Clinician Behavior When Less Is More. JAMA Intern Med. Published online October 12, 2015. PMID: 26457364 http://archinte.jamanetwork.com/article.aspx?articleid=2457399 - Howard DH, Gross CP Producing Evidence to Reduce Low-Value Care. JAMA Intern Med. Published online October 12, 2015 PMID: 26457957 http://archinte.jamanetwork.com/article.aspx?articleid=2457404
  9. Stammen LA et al Training Physicians to Provide High-Value, Cost-Conscious Care. A Systematic Review. JAMA. 2015;314(22):2384-2400 PMID: 26647260 http://jama.jamanetwork.com/article.aspx?articleid=2474425
  10. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  11. Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Yong PL, Saunders RS, Olsen LA, editors. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington (DC): National Academies Press (US); 2010. The National Academies Collection: Reports funded by National Institutes of Health. PMID: 21595114 Free Books & Documents. Free full text
  12. Hong AS, Ross-Degnan D, Zhang F, Wharam JF. Clinician-level predictors for ordering low-value imaging. JAMA Intern Med 2017 Sep 25; PMID: 28973068
  13. Packer M Are Payers the Leading Cause of Death in the United States? Milton Packer wonders if people suffer and die because it is cost effective. MedPage Today. Nov 1, 2017 https://www.medpagetoday.com/blogs/revolutionandrevelation/68935 - Thomas K, Ornstein C Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers. Drug companies and doctors have been accused of fueling the opioid crisis, but some question whether insurers have played a role, too. New York Times. Sept. 17, 2017 https://www.nytimes.com/2017/09/17/health/opioid-painkillers-insurance-companies.html
  14. Rosenbaum L The Less-Is-More Crusade - Are We Overmedicalizing or Oversimplifying? N Engl J Med 2017; 377:2392-2397. December 14, 2017 PMID: 29236644 Free full text http://www.nejm.org/doi/full/10.1056/NEJMms1713248
  15. Tsega S, O'Connor M, Poeran J, Iberti C, Cho HJ. Bedside assessment of the necessity of daily lab testing for patients nearing discharge. J Hosp Med 2018 Jan; 13:38 PMID: 29073318 https://www.journalofhospitalmedicine.com/jhospmed/article/149337/hospital-medicine/bedside-assessment-necessity-daily-lab-testing-patients
  16. Levinson W, Born K, Wolfson D Choosing Wisely Campaigns. A Work in Progress. JAMA. Published online April 19, 2018. PMID: 28600453 https://jamanetwork.com/journals/jama/fullarticle/2679354
  17. Cho HJ et al. Choosing wisely in adult hospital medicine: Co-creation of new recommendations for improved healthcare value by clinicians and patient advocates. J Gen Intern Med 2022 Jun 6; [e-pub] PMID: 35668237 https://link.springer.com/article/10.1007/s11606-021-07269-4
  18. Carroll AE. The high costs of unnecessary care. JAMA. 2017;318:1748-9. PMID: 29136432