Curbing Unwanted Healthcare Variability
By Peter Bonis, MD, chief medical officer, clinical effectiveness, Wolters Kluwer, Health.
Unwanted care variability is harmful, global and persistent.[i] It is a complex problem that is rooted in many factors including knowledge dissemination, patient preferences, patient adherence, resource availability, technology and healthcare financing approaches. Over-, under- and inappropriate utilization potentially harms patients and contributes meaningfully to the unsustainable trajectory of healthcare costs.
Despite the systemic challenges, there are two approaches healthcare leaders can adopt in the near-term to curb this variability.
- Provide evidence-based content
In every patient encounter, clinical decisions represent the finely balanced combination of patient preferences, evidence and clinician experience. These individual decisions can contribute to care variability in a region, among a population or for a particular condition.
To address this, many healthcare organizations enlist multidisciplinary clinical committees to build guidelines or protocols to standardize care. Yet, the burden of keeping such protocols routinely updated and the challenges in promoting their adoption ends up hampering their overall effectiveness.
Turning to technology solutions in the clinical workflow that help clinicians quickly find current, evidence-based clinical and drug information can help care teams align decision making, in both familiar and unfamiliar scenarios. It is important that such content be harmonized across user types. Physicians, allied health professionals, nurses, pharmacists and patients should all have access to the same evidence-based approaches.
- Empower patients
Patient engagement tools empower people to take ownership of their health outcomes. Several approaches are available including apps, interactive multimedia and leveraging interactive voice technology.
The benefits vary with the approach and with the conditions being addressed but the impact can be clinically important. For example, prescribing educational multimedia presentations for upcoming procedures can reduce anxiety and no-shows as patients better understand what to expect. Automated, personalized follow up calls after discharge can help nursing teams track thousands of patient readings, like pain levels and weight loss, that would be difficult to achieve with human power alone.
Turnkey fixes to cure unwanted care variability remain elusive. However, solutions that empower care teams and patients to align decision making and harmonize care are a promising start.
[i] Elshaug AG, Rosenthal MB, Lavis JN, Brownlee S, Schmidt H, Nagpal S, Littlejohns P, Srivastava D, Tunis S, Saini V. Levers for addressing medical underuse and overuse: achieving high-value health care. Lancet. 2017 Jul 8;390(10090):191-202. doi: 10.1016/S0140-6736(16)32586-7. Epub 2017 Jan 9. Review. PubMed PMID: 28077228.
Brownlee S, Chalkidou K, Doust J, Elshaug AG, Glasziou P, Heath I, Nagpal S, Saini V, Srivastava D, Chalmers K, Korenstein D. Evidence for overuse of medical services around the world. Lancet. 2017 Jul 8;390(10090):156-168. doi: 10.1016/S0140-6736(16)32585-5. Epub 2017 Jan 9. Review. PubMed PMID: 28077234; PubMed Central PMCID: PMC5708862.
Glasziou P, Straus S, Brownlee S, Trevena L, Dans L, Guyatt G, Elshaug AG, Janett R, Saini V. Evidence for underuse of effective medical services around the world. Lancet. 2017 Jul 8;390(10090):169-177. doi: 10.1016/S0140-6736(16)30946-1.
Epub 2017 Jan 9. Review. PubMed PMID: 28077232.