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System design. #highvaluecare

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Design Health Insurance for Overtreatment by Wei HU. Jamanetwork. Importance No guidelines exist currently for guideline panels and others considering changes to disease definitions.


Panels frequently widen disease definitions, increasing the proportion of the population labeled as unwell and potentially causing harm to patients. We set out to develop a checklist of issues, with guidance, for panels to consider prior to modifying a disease definition. 1-s2.0-S2213076416301671-main. Association of Primary Care Practice Location and Ownership With the Provision of Low-Value Care in the United States. Welcome. Two ways to identify clinical variation. There are many opportunities to reduce care variation in hospitals today—but how should you prioritize those opportunities?

Two ways to identify clinical variation

You should start by examining variation in two ways: "horizontal" and "vertical. " A horizontal approach focuses on the use of costly resources across multiple conditions, while a vertical approach analyzes performance within a particular condition or patient population to develop a consensus-based standard. Our infographic gives an example of each approach and explains the challenges of a horizontal approach versus the benefits of a vertical one. Download the infographic. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. + Author Affiliations CORRESPONDING AUTHOR: Thomas Bodenheimer, MD, Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California at San Francisco, Bldg 80-83, SF General Hospital, 995 Potrero Ave.

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

San Francisco, CA 94110, or Why The Best Hospitals Are Managed by Doctors. Healthcare has become extraordinarily complex — the balance of quality against cost, and of technology against humanity, are placing ever-increasing demands on clinicians.

Why The Best Hospitals Are Managed by Doctors

These challenges require extraordinary leaders. Doctors were once viewed as ill-prepared for leadership roles because their selection and training led them to become “heroic lone healers.” But this is changing. Implementation and de-implementation: two sides of the same coin? BMJ Quality & doi:10.1136/bmjqs-2016-005473 Special article.

Implementation and de-implementation: two sides of the same coin?

Assessing strategies for quality improvement. Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Divesting from ineffective and harmful medical practices has the potential to improve outcomes for patients, and mitigate the unsustainable rise in healthcare costs.

Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices

Abandonment (de-implementation) of medical interventions may depend on multiple factors. Empirical evidence from well-designed studies should count, but other considerations such as inertia, financial and professional conflicts, cultural and societal values, knowledge brokering, and lobbying may also be very important eventually. The question is how we can position evidence so as to be more informative and influential in these complex processes. Here we provide a framework to guide the evidence-based de-implementation of interventions, acknowledging how on-the-ground realities can enter these considerations. Contradicted established medical practices The number of medical practices where the best evidence shows no efficacy or harms outweighing benefits is substantial.

Unproven medical practices. Cedars-Sinai uses electronic records to spur improved, lower cost care. Last week, I told you about Sutter Health's efforts to orient its doctors toward more cost-conscious, high-quality care.

Cedars-Sinai uses electronic records to spur improved, lower cost care

As you might remember, the Northern California health system is gathering doctors and, using data culled from electronic health records, comparing individual doctors' practice patterns. Unwarranted variations in healthcare delivery: implications for academic medical centres. John E Wennberg (, directorAuthor affiliations Everyday clinical practice is characterised by wide variations that cannot be explained by illness severity or patient preference.

Unwarranted variations in healthcare delivery: implications for academic medical centres

Professor Wennberg examines the causes for these variations and suggests ways to remedy the situation Academic medicine has had only limited success in improving the scientific basis of everyday clinical practice, even within the walls of its own hospitals. Patterns of practice among academic medical centres—as among other institutions—are often idiosyncratic and unscientific, and local medical opinion and local supply of resources are more important than science in determining how medical care is delivered.

In short, after nearly 100 years of academic medicine as we know it, much of medicine in the United States remains empirical. Summary box. The Value of Low-Value Lists. An international groundswell of activity is seeking to identify and reduce the use of health care services that provide little or no benefit—whether through overuse or misuse.

The Value of Low-Value Lists

Health Systems Evidence. Choosing wisely: prevalence and correlates of low-value health care services in the United States. “Nudge” in the clinical consultation – an acceptable form of medical paternalism? Radiation From CT Scans May Raise Cancer Risk. BehaviouralInsightsInHealthCare. Great communication in healthcare can save lives.

We are only just beginning to learn about the power of words in health.

Great communication in healthcare can save lives

Not the great works of literature, whose influence goes without saying, but the power of the ordinary messages that patients and the public see every day. It turns out it matters exactly how they are framed and what they say. If we get it right, we can improve treatment, reduce errors, cut costs and even save lives. Take the text message that is routinely sent by NHS hospitals to outpatients reminding them of their upcoming appointment. A small tweak to the wording – to include the £160 cost of the appointment – reduced the non-attenders by almost 25% in a trial at Barts NHS trust in London. No extra effort is required or cost involved. It is the latest product of the nudge unit, established by the coalition government in 2010 and spun out of Whitehall last year, working together with the Institute of Global Health Innovation at Imperial College London, which I lead.

GP quality and outcomes framework indicators focus on the wrong issues. In the last few months the government has been engaged in lengthy discussions with the British Medical Association on how best to introduce further reforms within general practice. The talks between the government and the BMA's general practitioners committee (GPC) have now broken down and we are being told the government wants to impose changes to the 2013-14 GP contract. This is at a time when we are already dealing with significant challenges through GP commissioning and the drive to make efficiency savings, while continuing to offer high levels of patient care. The key areas of contention are variability in funding between practices, which I have previously written about, and quality and outcomes framework (QOF) indicators.

Many small practices rely on QOF payments to balance their books. QOF contains groups of indicators against which practices are scored depending on their level of achievement in improving patient care. Giving Doctors Grades. ONE summer day 14 years ago, when I was a new cardiology fellow, my colleagues and I were discussing the case of an elderly man with worsening chest pains who had been transferred to our hospital to have coronary bypass surgery. We studied the information in his file: On an , his coronary arteries looked like sausage links, sectioned off by tight blockages. He had , and poor kidney function, and in the past he had suffered a heart attack and a stroke. Could the surgeons safely operate? In most cases, surgeons have to actually see a patient to determine whether the benefits of surgery outweigh the risks. Achieving Value in Primary Care: The Primary Care Value Model.

A 2012 review of studies assessing the impact of practice transformation that included 3 or more elements of PCMH found evidence to be of low quality, with some favorable but largely inconclusive effects on processes and outcomes of care, use of emergency departments and hospital admissions, and patient experience.2 A 2014 review of initiatives meeting requirements for PCMH and using randomized or controlled methods found a small to moderate positive impact on patient experience, preventive care, and emergency department use, but no impact on overall cost.3 A 2015 review including all articles identified in a search for PCMH found reductions in health care use and cost, and improvement in quality and patient experience metrics in some peer-reviewed and non–peer-reviewed reports.4 Other studies published within the past 3 years have shown similarly varying results.5–9 Interpreting Mixed Findings. Should primary care guidelines be written by family physicians?

G. Michael Allan, MD CCFP⇑ + Author Affiliations Correspondence: Dr G. The importance of being different. Paying doctors bonuses for better health outcomes makes sense in theory. But it doesn't work. Doctors Be Forewarned: Eliminate Wasteful Medical Practices Or Expect A Pay Cut. Paying more wisely: effects of payment reforms on evidence-based clinical decision-making, Journal of Comparative Effectiveness Research, Future Medicine. We really want to pay for quality, but it’s so darn hard. Paying for quality, not quantity is getting to be almost cliche. Recently, the Obama administration doubled down, however, announcing ambitious targets for Medicare payments to be “tied to” quality in the future. Unfortunately, the evidence behind such programs working continues to elude us.