Value based healthcare

Gray, Muir

doi:10.1136/bmj.j437

Cited by 112 publications

(76 citation statements)

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“…However, the cost for readmissions in the 30 days postdischarge was less for the experimental ward compared to the comparison ward, with a net result of a non‐significant difference between wards for total cost. Consistent with the principles of value‐based health care, the results of this trial will help policymakers to make informed decisions about how to allocate scarce health‐care resources in GEM …”

Section: Discussionmentioning

confidence: 85%

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Saturday allied health services for geriatric evaluation and management: A controlled before‐and‐after trial

et al. 2019

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Objective To assess the effect of Saturday allied health services on a geriatric evaluation and management ward. Methods A controlled before‐and‐after trial at two wards. Allied health services were added to usual weekday staffing on Saturdays for 6 months on the experimental ward. Length of stay, functional independence, readmissions, discharge destination and costs were evaluated at pre‐intervention (N = 331) and intervention (N = 462). Results Relative to the comparison ward, the experimental ward had longer length of stay (mean 7.8 days, 95% CI 4.7‐10.8), fewer readmissions (mean 3.1 days, 95% CI 0.6‐5.7) and no difference in the proportion discharged home. Cost‐effectiveness demonstrated no significant difference in cost ($2639, 95% CI $‐386 to $5647) and functional independence gain (3.6 units, 95% CI 0.8‐6.5) favouring the experimental ward. Conclusion These findings do not support the provision of additional Saturday allied health services in geriatric evaluation and management to reduce length of stay.

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Section: Discussionmentioning

confidence: 85%

“…One reason why Saturday allied health services may not be provided more commonly in GEM is the cost of staffing these services. In the context of the need for value‐based health care, evaluating Saturday allied health services is important so that health‐care resources are allocated efficiently …”

Section: Introductionmentioning

confidence: 99%

Saturday allied health services for geriatric evaluation and management: A controlled before‐and‐after trial

et al. 2019

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“…Thus, regulatory and funding environments may be critical in changing the behaviour of practitioners. Health systems are increasingly applying the principles of ‘value‐based’ care in which efficacy, adverse events and cost are considered in the context of a specific intervention . Jurisdictions vary in their approaches to the application of value‐based care, but the withdrawal or reduction of funding for specific procedures may have the strongest effect on practice …”

Section: Potential Remedies For Cognitive Dissonancementioning

confidence: 99%

Cognitive dissonance: how self‐protective distortions can undermine clinical judgement

Klein

McColl

2019

Medical Education

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Context When errors occur in clinical settings, it is important that they are recognised without defensiveness so that prompt corrective action can be taken and learning can occur. Cognitive dissonance – the uncomfortable tension we experience when we hold two or more inconsistent beliefs – can hinder our ability to respond optimally to error. Objectives The aim of this paper is to describe the effects of cognitive dissonance, a construct developed and tested in social psychology. We discuss the circumstances under which dissonance is most likely to occur, provide examples of how it may influence clinical practice, discuss potential remedies and suggest future research to test these remedies in the clinical context. Methods We apply research on cognitive dissonance from social psychology to clinical settings. We examine the factors that make dissonance most likely to occur. We illustrate the power of cognitive dissonance through two medical examples: one from history and one that is ongoing. Finally, we explore moderators at various stages of the dissonance process to identify potential remedies. Results We show that there is great opportunity for cognitive dissonance to distort judgements, delay optimal responses and hinder learning in clinical settings. We present a model of the phases of cognitive dissonance, and suggestions for preventing dissonance, reducing the distortions that can arise from dissonance and inhibiting dissonance‐induced escalation of commitment. Conclusions Cognitive dissonance has been studied for decades in social psychology but has not had much influence on medical education research. We argue that the construct of cognitive dissonance is very relevant to the clinical context and to medical education. Dissonance has the potential to interfere with learning, to hinder the process of coping effectively with error, and to make the accepting of change difficult. Fortunately, there is the potential to reduce the negative impact of cognitive dissonance in clinical practice.

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“…Evidence in this context can refer to knowledge and information in a variety of forms: the current best scientific research evidence, practitioner expertise and judgment, patient narratives (Charon, 2006), and/or other contextual factors (such as cultural or traditional knowledge; Brownson, Baker, Leet, Gillespie, & True, 2010). Writ broadly in this way, EBHC activities encompass all practices, behaviors, and skills that rely explicitly on information and knowledge across all areas of health care (Gray, 2010).…”

Section: Ebhc Activitiesmentioning

confidence: 99%

Aligning information technologies with evidence-based health-care activities: A design and evaluation framework

Sedig¹,

Naimi²,

Haggerty³

2017

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Value based healthcare

Abstract: Reducing unwarranted variation to maximise the value of healthcare for populations

Cited by 112 publications

References 1 publication

Saturday allied health services for geriatric evaluation and management: A controlled before‐and‐after trial

Saturday allied health services for geriatric evaluation and management: A controlled before‐and‐after trial

Cognitive dissonance: how self‐protective distortions can undermine clinical judgement

Aligning information technologies with evidence-based health-care activities: A design and evaluation framework

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