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Enhanced Support For Shared Decision Making Reduced Costs Of Care For Patients With Preference-Sensitive Conditions
Shared decision making is an approach to care that seeks to fully inform patients about the risks and benefits of available treatments and engage them as participants in decisions about the treatments. Although recent federal and state policies pursue the expanded use of shared decision making as a way to improve care quality and patient experience, payers and providers want evidence that this emerging model of care is cost-effective. We examined data obtained from a yearlong randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support. The enhanced-support group had 12.5 percent fewer hospital admissions than the usual-support group, and 9.9 percent fewer preference-sensitive surgeries, including 20.9 percent fewer preference-sensitive heart surgeries. These findings indicate that support for shared decision making can generate savings. They also suggest that a \"remote\" model of support-combining telephonic coaching with decision aids, for example-may constitute a relatively low-cost and effective intervention that could reach broader populations without the need for the direct involvement of regular medical care team members. [PUBLICATION ABSTRACT]
Journal Article
An urgent call to raise the bar in oncology
Important breakthroughs in medical treatments have improved outcomes for patients suffering from several types of cancer. However, many oncological treatments approved by regulatory agencies are of low value and do not contribute significantly to cancer mortality reduction, but lead to unrealistic patient expectations and push even affluent societies to unsustainable health care costs. Several factors that contribute to approvals of low-value oncology treatments are addressed, including issues with clinical trials, bias in reporting, regulatory agency shortcomings and drug pricing. With the COVID-19 pandemic enforcing the elimination of low-value interventions in all fields of medicine, efforts should urgently be made by all involved in cancer care to select only high-value and sustainable interventions. Transformation of medical education, improvement in clinical trial design, quality, conduct and reporting, strict adherence to scientific norms by regulatory agencies and use of value-based scales can all contribute to raising the bar for oncology drug approvals and influence drug pricing and availability.
Journal Article
Defining the concept of fair pricing for medicines
Suerie Moon and colleagues consider what makes a fair price for both buyers and sellers
Journal Article
Pursuing the Triple Aim: The First 7 Years
Context: In 2008, researchers at the Institute for Healthcare Improvement (IHI) described the Triple Aim as simultaneously \"improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.\" IHI and its close colleagues had determined that both individual and societal changes were needed. Methods: In 2007, IHI began recruiting organizations from around the world to participate in a collaborative to implement what became known as the Triple Aim. The 141 participating organizations included health care systems, hospitals, health care insurance companies, and others closely tied to health care. In addition, key groups outside the health care system were represented, such as public health agencies, social services groups, and community coalitions. This collaborative provided a structure for observational research. By noting the contrasts between the contexts and structures of those sites in the collaborative that progressed and those that did not, we were able to develop an ex post theory of what is needed for an organization or community to successfully pursue the Triple Aim. Findings: Drawing on our 7 years of experience, we describe the 3 major principles that guided the organizations and communities working on the Triple Aim: creating the right foundation for population management, managing services at scale for the population, and establishing a learning system to drive and sustain the work over time. Conclusions: The concept of the Triple Aim is now widely used, because of IHI's work with many organizations and also because of the adoption of the Triple Aim as part of the national strategy for US health care, developed during the implementation of the Patient Protection and Affordable Care Act of 2010. Even those organizations working on the Triple Aim before IHI coined the term found our concept to be useful because it helped them think about all 3 dimensions at once and organize their work around them.
Journal Article
Cost management of construction projects
\"The cost manager/quantity surveyor plays a pivotal role in the financial and contract management of construction projects, although the exact nature of the service they provide depends on the project employer's terms of engagement. This can mean acting as consultant in a range of roles including cost and advisory services for budget setting to initiate a project, cost management through the design and construction phases, contract administration and acting as the client side project manager to oversee the entire building process.Cost Management of Construction Projects focusses on the cost manager/quantity surveyor engaged by the project client, and discusses key elements that help drive project success including measurement (based on the New Rules of Measurement published by RICS), procurement, cost planning, contract administration and project cost management. With examples, it provides a thorough guide to the role in the workplace and in the field, directly addressing the day to day situations faced by the cost manager/quantity surveyor\"-- Provided by publisher.
Book
China’s new policy for healthcare cost-control based on global budget: a survey of 110 clinicians in hospitals
Background
The increasing cost on healthcare exposes China’s healthcare budgets and system to financial crisis. To control the excessive growth of healthcare expenditure, China’s healthcare reforms emphasize the control of the global budget for healthcare, which leads to the release of relevant policy and a series of cost-control actions implemented by different hospitals. This work aims to identify the effects brought by the cost-control policy and actions via surveying and analysing feedback from clinicians.
Methods
Questionnaires on the cost-control policy and actions were designed for surveying 110 clinicians in hospitals from different regions of China. The data on the implementation of the cost-control actions and doctors’ feedback on these actions were analysed using descriptive statistics. Pearson’s chi-squared tests were performed to detect associations between doctors’ opinions and specific cost-control actions. A value of
p
< 0.05 was considered statistically significant. Association relationships between doctors’ opinions and cost-control actions were modelled into network models, and key factors were identified in a multi-variate framework. Last, we visualized our resultant data using a network model, and further multi-variate analysis was performed.
Results
There were three main findings. (1) The cost-control policy has been widely implemented in the sampled hospitals in different regions of China, with more than 80% of those surveyed acknowledging that their hospitals take actions of reducing average prescription fees for outpatients, drug costs, and in-hospitalization durations. (2) Most doctors have a negative view of some cost-control actions; this is mainly due to concerns about the effects of these actions on the doctors’ own healthcare performance and patient satisfaction. (3) Cost-control actions that had a significant impact on doctors’ performance included limiting average prescription fees for outpatients and limiting the use of examinations/drugs/surgeries. Decreased patient satisfaction was associated with fewer admissions of critically ill patients, reduced use of brand-name drugs, and increased total costs to patients due to increased frequencies of visits to the hospitals.
Conclusions
Cost-control actions implemented in hospitals in response to the government’s policy to reduce its national healthcare budget affect both doctors and patients in several ways. Moreover, the cost-control policy and actions can be improved.
Journal Article