Best Care at Lower Cost The Path to Continuously Learning Health Care in America (2013) / Chapter Skim
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3 Imperative: Achieving Greater Value in Health Care
3 Imperative: Achieving Greater Value in Health Care
Pages 91-110
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From page 91... ...
3 Imperative: Achieving Greater Value in Health Care Thomas Kundig periodically suffered back pain from an old rock climbing accident. When the pain recurred, he would contact his clinician, only to wait for at least a week to obtain an appointment with a specialist.
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From page 92... ...
A recent study found that 86 percent of adverse events were not submitted to existing hospital incident reporting systems, partly because of confusion about what constitutes patient harm (Levinson, 2012)
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From page 93... ...
For example, there are proven methods for preventing catheter-related bloodstream infections, especially in intensive care unit (ICU) settings (Pronovost et al., 2006)
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From page 94... ...
The Evidence Basis for Care Another area for improvement is ensuring that clinical evidence guides patient care. For example, Americans receive only about half of the preventive, acute, and chronic care recommended by current research and evidence-based guidelines (McGlynn et al., 2003)
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From page 95... ...
A recent survey revealed that patients experience problems with receiving results of medical tests and information about their medical history and that test results frequently are unavailable at the time of doctors' appointments. Almost 20 percent of patients reported that test results or medical records were not transferred from another provider or a laboratory in time for an appointment.
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From page 96... ...
. These rehospitalizations were responsible for $15 billion in Medicare spending in 2005 alone (Medicare Payment Advisory Commission, 2008)
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From page 97... ...
In one survey, 29 percent of patients reported having difficulty obtaining an appointment with their health care provider when sick, while almost 60 percent noted problems with obtaining care outside of traditional business hours (nights, weekends, holidays) without going to the emergency room (Stremikis et al., 2011)
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From page 98... ...
. For example, life expectancy at birth is 4-6 years less for African Americans than for Caucasians, and the mortality rate for African American infants is double the national average (National Center for Health Statistics, 2011)
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From page 99... ...
• Preventable medical harm is pervasive, despite proven methods for its reduction. One study found that nearly one in five hospital patients are harmed during their stay, and nearly two-thirds of that harm is preventable.
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From page 100... ...
For the public, the cost of health care is consuming more of every paycheck and rising higher than any increases in pay. In the past decade, the average income for a family of four with health insurance rose by 30 percent, while the family's health care costs (including health insurance premiums 2 All monetary estimates were converted to 2009 dollars using the Consumer Price Index inflation estimates unless otherwise noted (U.S.
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From page 101... ...
Estimates vary on waste and excess health care costs, but they are large. The IOM workshop summary The Healthcare Imperative: Lowering Costs and Improving Outcomes assesses waste by evaluating excess costs in six domains: unnecessary services, services inefficiently delivered, prices that are too high,4 excess administrative costs, missed prevention opportunities, and medical fraud (IOM, 2010)
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From page 102... ...
While there are methodological issues with each approach to estimating excess costs, the consistently large figures resulting from each approach signal the potential for reducing health care costs while improving quality and health outcomes.
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From page 103... ...
. 7 he average premiums for a single worker were calculated using the Kaiser Family Foun T dation's 2009 Employer Health Benefits survey, with the size of the 2009 civilian labor force being derived from Bureau of Labor Statistics estimates (Kaiser Family Foundation and Health Research & Educational Trust, 2009; U.S.
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From page 104... ...
The total amount of unnecessary health care costs and waste in 2009 was an estimated $750-$765 billion, more than a third of total health care expenditures. • Wasteful health expenditures directly stifle progress on other priori ties.
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From page 105... ...
The problems of shortfalls in outcomes and cost excesses can be addressed through the application of tools and strategies that enable continuous learning and improvement in care delivery, the subject of the next chapter. REFERENCES AHRQ (Agency for Healthcare Research and Quality)
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From page 106... ...
2011. The effect of guided care teams on the use of health services: Results from a cluster-randomized controlled trial.
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From page 107... ...
2011. DoD health care: Prohibition on financial incentives that may influence health insurance choices for retirees and their dependents under age 65.
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From page 108... ...
:1418-1428. Kaiser Family Foundation and Health Research & Educational Trust.
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From page 109... ...
Washington, DC: Medicare Payment Advisory Commission. National Association of State Budget Officers.
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From page 110... ...
2009. Adequacy of hospital discharge summaries in documenting tests with pending results and outpatient follow-up providers.
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