Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality

Lee, Vivian S.; Kawamoto, Kensaku; Hess, Rachel; Park, Charlton; Young, Jeffrey; Hunter, Cheri; Johnson, Steven A.; Gulbransen, Sandi; Pelt, Christopher E.; Horton, Devin; Graves, Kevin G.; Greene, Tom; Anzai, Yoshimi; Pendleton, Robert C.

doi:10.1001/jama.2016.12226

Cited by 247 publications

(221 citation statements)

References 25 publications

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“…Of note, this rate is actually lower than a report from the USA, where up to 40% of patients received laboratory and imaging services outside their home health maintenance organisation (and thus not captured in its electronic records) 23. However, the direction of this bias serves to strengthen our findings since it would have led to an underestimate of the prevalence of low-value care.…”

Section: Discussionmentioning

confidence: 49%

Frequency of low-value care in Alberta, Canada: a retrospective cohort study

et al. 2017

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Objective To determine how frequently 10 low-value services highlighted by Choosing Wisely are done and what factors influence their provision. Methods This is a retrospective cohort study using routinely collected health data from five linked data sets from 2012 to 2015 in the Canadian province of Alberta to determine the frequency with which 10 low-value services were provided. Results Between 2012 and 2015, 162 143 people (4% of all 3 814 536 adult Albertans and 5% of the 3 423 135 who saw a physician at least once in that time frame) received at least one of the 10 low-value services, including 29.8% of Albertans older than 75 years (57 811 of 194 068). The proportion of adults receiving low-value services ranged from carotid artery imaging in 0.1% of asymptomatic adults without cerebrovascular disease, to prostate-specific antigen (PSA) testing in 55.5% of men 75 years or older without a history of prostate cancer. Although age, Charlson scores and frequency of primary care visits were associated with low-value service provision, the directions of the association differed across services; however, higher socioeconomic status, increased frequency of specialist contact and higher ratio of specialists to primary care physicians in the patient's region were associated with an increased risk of receiving all of the low-value services we examined. The low-value services which resulted in the greatest costs to the healthcare system were cervical cancer screening in women older than 65 without history of cervical dysplasia or genital cancer, PSA testing in men older than 75 without history of prostate cancer and preoperative stress testing/cardiac imaging before non-cardiac surgery. Conclusions Even within a universal coverage healthcare system, the proportion of patients receiving low-value services varied widely (from <0.1% to 56%). Increased use was associated with higher socioeconomic status, increased frequency of specialist contact and higher ratio of specialists to primary care physicians.

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Section: Discussionmentioning

confidence: 49%

Frequency of low-value care in Alberta, Canada: a retrospective cohort study

et al. 2017

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“…More recently, an uncontrolled, pre-post, longitudinal, observational study measuring quality and outcomes relative to cost at University of Utah Health Care involving clinical projects such as total hip and knee and joint replacement, hospitalist, laboratory utilization and management of sepsis showed both reduced costs and improved quality with a shift from volume to value. Compared with the baseline year, mean direct costs were shown to be 7% lower in implementation year and 11% lower in the post-implementation year [24]. There could be a role for implementation of a value-driven outcomes tool to achieve similar cost-reductions in the care of dry eye.…”

Section: Systems-level Benefits In Proposed Modelmentioning

confidence: 95%

From Volume to Value: Prospects and Pitfalls in Organising Integrated Dry Eye Practice Units

Goh¹,

Korne²,

Tong³

2017

J Clin Exp Ophthalmol

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With the advent of aging populations, chronic multifactorial diseases will dominate and strain existing models of health care. A model of healthcare delivery that emphasizes seamless, integrated, team-based care and remuneration for patient outcomes, have proven advantageous in diseases like diabetes mellitus, compared to systems based on isolated medical services. It is, however, unclear whether major chronic ophthalmic diseases including dry eye are also suitable for this model. Multiple co-morbidities such as depression, anxiety, postmenopausal mood swings, sleep disorders, and chronic neuropathic pain in dry eye greatly and unexpectedly increase its healthcare burden, and also produce high levels of patient and physician frustration. Many patients benefit from counseling, social support, and psychological management, but are frustrated by multiple referrals and inefficiency in care coordination. With the new model, patients may have a seamless transition between care settings, better experience and improved outcomes, and likely attain added value per unit cost.Keywords: Eye diseases; Health policy; Practice guidelines as topic; Primary health care; Quality of health care Rethinking Care for Chronic DiseasesThe trend of medical sub-specialization with the development and proliferation of organ-based or medical technique-based healthcare centers has clearly benefited many generations of people in developed and even developing countries [1]. The advantages of providing highend care are mainly in single, acute problems requiring specialized skills. However, incurable and disabling chronic multi-organ diseases are increasing, due to aging of communities and partly, success of specialized disciplines in management of treatable maladies. We define chronic disease as by WONCA International Classification Committee: a health condition that is long in duration-often with long latency and protracted course, multi-factorial in aetiology, no definite cure, changes gradually over time, heterogeneous in susceptibility" [2], including the lived experience of coping with health disruption and impact on psychological and social function [3].In chronic diseases with multiple comorbidities, health-care disciplines should be integrated and centered on the patient. The "Esther network" [4] and Ed Wagner's chronic disease model [5] are examples of integration across the entire continuum of care, including self and community care, which also cater to the bio psychosocial needs of a person [6]. A study involving 113,452 unique patients evaluated the integration of primary healthcare family practice, internal medicine and geriatric practices, and found superior outcomes in terms of depression screening rates and increased adherence to care, with less emergency visits/admissions [7].The traditional model of healthcare, pivoted around specialized tertiary centers ( Figure 1A), is not optimized for chronic disease care. Traditional healthcare models are largely 'serviced-based' , whereby patients are typically charged for each i...

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“…A study by Lee et al 6 demonstrated that value could be improved when a "value team" comprised of health care administrators and providers of different specialties (eg, physicians, nurses, physical therapists, nutritionists) assessed the benefits and costs of a specific intervention such as hip replacement. The team approach led to shorter hospital stays, decreased rates of readmissions and complications, better rates of patient satisfaction, and reduced cost.…”

mentioning

confidence: 99%

“…The team approach led to shorter hospital stays, decreased rates of readmissions and complications, better rates of patient satisfaction, and reduced cost. 6 In general, health care systems are adopting evidence-based clinical pathways for the management of specific conditions 7 ; however, more time is needed to establish whether this reasonable approach focused on the process of care will be translated into value-based care.…”

mentioning

confidence: 99%

Finally, a Practical Approach to Value-Based Medicine

Balducci

2017

Cancer Control

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Implementation of a Value-Driven Outcomes Program to Identify High Variability in Clinical Costs and Outcomes and Association With Reduced Cost and Improved Quality

Cited by 247 publications

References 25 publications

Frequency of low-value care in Alberta, Canada: a retrospective cohort study

Frequency of low-value care in Alberta, Canada: a retrospective cohort study

From Volume to Value: Prospects and Pitfalls in Organising Integrated Dry Eye Practice Units

Finally, a Practical Approach to Value-Based Medicine

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