Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review

Conombo, Blanchard; Guertin, Jason R.; Tardif, Pier‐Alexandre; Gagnon, Marc-Aurèle; Duval, C; Archambault, Patrick; Berthelot, Simon; Lauzier, François; Turgeon, Alexis F.; Stelfox, Henry T.; Chassé, Michaël; Hoch, Jeffrey S.; Gabbe, Belinda; Champion, Howard R.; Lecky, Fiona; Cameron, Peter; Moore, Lynne

doi:10.1016/j.jval.2021.10.018

Cited by 3 publications

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References 60 publications

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“…More broadly, according to a systematic review, less than 2% of QIs used to evaluate health care target low-value care. 11 We recently developed a trauma-specific list of QIs targeting low-value clinical practices for trauma care using a scoping review of the literature, 12 syntheses of evidence on benefits and harms, 13,14 an evaluation of cost-effectiveness, 15 and an expert consensus study. 16 Two panels of international (76% participation [25 of 33]) and local stakeholders (94% participation [15 of 16]), and 3 patient partners identified 16 clinical practices whose use should be questioned and assessed with QIs.…”

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Validation of Quality Indicators Targeting Low-Value Trauma Care

et al. 2022

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ImportanceReducing low-value care has the potential to improve patient experiences and outcomes and free up health care resources. Sixteen quality indicators were recently developed targeting reductions in low-value trauma care based on a synthesis of the best available evidence, expert consensus, and patient preferences.ObjectiveTo assess the validity of quality indicators on low-value trauma care using trauma registry data.Design, Setting, and ParticipantsData from an inclusive Canadian provincial trauma system were used in this analysis. Included were all admissions for injury to any of the 57 provincial adult trauma centers between April 1, 2013, and March 31, 2020. Metrics for quality indicators were developed iteratively with clinical experts.Main Outcomes and MeasuresValidity was assessed using a priori criteria based on 5 parameters: frequency (incidence and case volume), discrimination (interhospital variation), construct validity (correlation with quality indicators on high-value care), predictive validity (correlation with quality indicators on risk-adjusted outcomes), and forecasting (correlation over time).ResultsThe study sample included 136 783 patient admissions (mean [SD] age, 63 [22] years; 68 428 men [50%]). Metrics were developed for 12 of the 16 quality indicators. Six quality indicators showed moderate or high validity on all measurable parameters: initial head, cervical spine, or whole-body computed tomography for low-risk patients; posttransfer repeated computed tomography; neurosurgical consultation for mild complicated traumatic brain injury; and spine service consultation for isolated thoracolumbar process fractures. Red blood cell transfusion in low-risk patients had low frequency but had moderate or high validity on all other parameters. Five quality indicators had low validity on at least 2 parameters: repeated head CT and intensive care unit admission for mild complicated traumatic brain injury, hospital admission for minor blunt abdominal trauma, orthosis for thoracolumbar burst fractures, and surgical exploration in penetrating neck injury without hard signs.Conclusions and RelevanceThis cohort study shows the feasibility of assessing low-value trauma care using routinely collected data. It provided data on quality indicators properties that can be used to decide which quality indicators are most appropriate in a given system. Results suggest that 6 quality indicators have moderate to high validity. Their implementation now needs to be tested.

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Validation of Quality Indicators Targeting Low-Value Trauma Care

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Evaluating the effectiveness of a multifaceted intervention to reduce low-value care in adults hospitalized following trauma: a protocol for a pragmatic cluster randomized controlled trial

et al. 2023

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Background While simple Audit & Feedback (A&F) has shown modest effectiveness in reducing low-value care, there is a knowledge gap on the effectiveness of multifaceted interventions to support de-implementation efforts. Given the need to make rapid decisions in a context of multiple diagnostic and therapeutic options, trauma is a high-risk setting for low-value care. Furthermore, trauma systems are a favorable setting for de-implementation interventions as they have quality improvement teams with medical leadership, routinely collected clinical data, and performance-linked to accreditation. We aim to evaluate the effectiveness of a multifaceted intervention for reducing low-value clinical practices in acute adult trauma care. Methods We will conduct a pragmatic cluster randomized controlled trial (cRCT) embedded in a Canadian provincial quality assurance program. Level I–III trauma centers (n = 30) will be randomized (1:1) to receive simple A&F (control) or a multifaceted intervention (intervention). The intervention, developed using extensive background work and UK Medical Research Council guidelines, includes an A&F report, educational meetings, and facilitation visits. The primary outcome will be the use of low-value initial diagnostic imaging, assessed at the patient level using routinely collected trauma registry data. Secondary outcomes will be low-value specialist consultation, low-value repeat imaging after a patient transfer, unintended consequences, determinants for successful implementation, and incremental cost-effectiveness ratios. Discussion On completion of the cRCT, if the intervention is effective and cost-effective, the multifaceted intervention will be integrated into trauma systems across Canada. Medium and long-term benefits may include a reduction in adverse events for patients and an increase in resource availability. The proposed intervention targets a problem identified by stakeholders, is based on extensive background work, was developed using a partnership approach, is low-cost, and is linked to accreditation. There will be no attrition, identification, or recruitment bias as the intervention is mandatory in line with trauma center designation requirements, and all outcomes will be assessed with routinely collected data. However, investigators cannot be blinded to group allocation and there is a possibility of contamination bias that will be minimized by conducting intervention refinement only with participants in the intervention arm. Trial registration This protocol has been registered on ClinicalTrials.gov (February 24, 2023, #NCT05744154).

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Advancing Healthcare

Komalasari

2024

Future of AI in Medical Imaging

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This study explores the economic implications of immediate magnetic resonance imaging (MRI) in treating suspected scaphoid fractures. Historically, conventional methods have been used, but recent advancements have introduced MRI into acute care settings, challenging established diagnostic paradigms. The study aims to close the empirical-economic evidence gap on the prompt use of MRI in cases with suspected scaphoid fractures, providing insight into cost-effectiveness, resource use, and overall healthcare efficiency. The literature study illuminates the evolution of diagnostic approaches for scaphoid fractures, highlighting the limitations of conventional methods. The findings underscore the pivotal role of MRI in scaphoid fracture management, demonstrating cost-effectiveness and enhanced healthcare outcomes, challenging traditional diagnostic pathways.

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Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review

Cited by 3 publications

References 60 publications

Validation of Quality Indicators Targeting Low-Value Trauma Care

Validation of Quality Indicators Targeting Low-Value Trauma Care

Evaluating the effectiveness of a multifaceted intervention to reduce low-value care in adults hospitalized following trauma: a protocol for a pragmatic cluster randomized controlled trial

Advancing Healthcare

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