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

Introduction

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
  • 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

Notes

• diagnoses derived from administrative data do not distinguish appropriate from inappropriate emergency department visits
• malpractice reform alone will not reduce the cost the use of high-cost medical imaging in the emergency department
• low-value imaging is associated significantly with owning imaging equipment
• little correlation between higher spending & higher quality of care
• nearly 30% of health care costs are spent on unnecessary tests & treatments
• ordering unnecessary diagnostic testing does not alleviate patient fears & concerns
• a daily reminder to decrease lab testing can significantlu lower ordering of unnecessary predischarge blood tests
• 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
  • case made for payer role in opioid crisis, through denial of payment for newer, more expensive less-addictive opioids

Additional terms

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