HEALTH CARE OUTCOMES: WHEN THE MORE EFFECTIVE CHOICE COSTS MORE
(Part 2 out of 2)
(Part 2 out of 2)
by Mark Pauly
Effective Choices
The second point deals with whether doctors make clinical choices that would be altered by better evidence, when and if such evidence becomes available. One example in the essay — of efforts to identify patients at high risk of hospital readmission — assumes (but provides no evidence to prove) that there are things doctors could do to reduce the likelihood of readmission once the patients likely to be readmitted were targeted.
There are programs evaluated by rigorous research that reduce readmission rates, and they show that the best interventions emphasize non-physicians (specially trained nurses or community-based workers).
There is, of course, much that physicians can do in terms of explaining what to expect after discharge to patients and being available if problems arise that can head off readmissions, but their role in transitional care (and their willingness to respond to evidence on how to perform that role) is only part of an effective plan.
Moving toward a medical care system that provides greater value relative to cost, and reduces cost where value falls short, is a task that will require many changes — in provider payment, in tax subsidies to “Cadillac” health insurance, in information to engage consumers, in teamwork among medical care providers, and in changes in the community to reduce the risk of illness and injury.
The diffusion of information among physicians about improvements in clinical care appears to be fairly rapid in general though there are, of course, examples of resistance and delay.
Often that delay occurs because the evidence is not conclusive or fully persuasive; it is interesting that the example of physician delay in the essay — of failure to adopt a new sepsis drug — was, with the benefit of hindsight, a prudent choice because subsequent clinical information showed that the costly drug failed to demonstrate a survival benefit, and so was withdrawn from the market at the request of the FDA.
Beyond exhortation to pay attention and do better, it is likely that effective systems to increase physician attention to evidence will not be able to be imposed by regulation or direct government programs, but will need to be embedded in improved models of care delivery that rely on better reimbursement and organizational structures that provide stronger motivation to acquire and use information, such as the Accountable Care Organizations for Medicare that are part of health reform.
Even there, the jury is still out on the overall and cost effectiveness. My expectation is that improvements will come from improved incentives to all players for making better choices between increased cost and heightened outcomes. Spending growth is already slowing as some incentives are changing, so there is reason for hope — but still a long way to go.
The second point deals with whether doctors make clinical choices that would be altered by better evidence, when and if such evidence becomes available. One example in the essay — of efforts to identify patients at high risk of hospital readmission — assumes (but provides no evidence to prove) that there are things doctors could do to reduce the likelihood of readmission once the patients likely to be readmitted were targeted.
There are programs evaluated by rigorous research that reduce readmission rates, and they show that the best interventions emphasize non-physicians (specially trained nurses or community-based workers).
There is, of course, much that physicians can do in terms of explaining what to expect after discharge to patients and being available if problems arise that can head off readmissions, but their role in transitional care (and their willingness to respond to evidence on how to perform that role) is only part of an effective plan.
Moving toward a medical care system that provides greater value relative to cost, and reduces cost where value falls short, is a task that will require many changes — in provider payment, in tax subsidies to “Cadillac” health insurance, in information to engage consumers, in teamwork among medical care providers, and in changes in the community to reduce the risk of illness and injury.
The diffusion of information among physicians about improvements in clinical care appears to be fairly rapid in general though there are, of course, examples of resistance and delay.
Often that delay occurs because the evidence is not conclusive or fully persuasive; it is interesting that the example of physician delay in the essay — of failure to adopt a new sepsis drug — was, with the benefit of hindsight, a prudent choice because subsequent clinical information showed that the costly drug failed to demonstrate a survival benefit, and so was withdrawn from the market at the request of the FDA.
Beyond exhortation to pay attention and do better, it is likely that effective systems to increase physician attention to evidence will not be able to be imposed by regulation or direct government programs, but will need to be embedded in improved models of care delivery that rely on better reimbursement and organizational structures that provide stronger motivation to acquire and use information, such as the Accountable Care Organizations for Medicare that are part of health reform.
Even there, the jury is still out on the overall and cost effectiveness. My expectation is that improvements will come from improved incentives to all players for making better choices between increased cost and heightened outcomes. Spending growth is already slowing as some incentives are changing, so there is reason for hope — but still a long way to go.
Fuente: KNOWLEDGE@WHARTON
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¿Cómo INCORPORAR y APLICAR Modelos de
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PENSAMIENTO ESTRATÉGICO?
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http://msg-latam-meic.blogspot.com.ar/2014/06/capacitacion-in-company-programa_6246.html
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