All posts in High-value Care

“Total knee arthroplasty is a common procedure for end stage osteoarthritis of the knee, with more than 100,000 knee arthroplasties performed each year in the United Kingdom and more than 700,000 in the United States. Projections of future surgical volumes suggest further substantial increases. Although total knee arthroscopy is effective at reducing pain and improving physical function for most patients, around 20% report dissatisfaction with the postoperative outcome. [..] Meta-analyses suggest that uniform postoperative physiotherapy for all patients after total knee arthroplasty compared with no treatment offers short term benefit but is not effective at improving patient outcomes at one … Read More

“Use of noninvasive ventilation (NIV), such as continuous or bilevel positive airway pressure, has increased in select populations of patients with respiratory failure (eg, those with acute exacerbations of chronic obstructive pulmonary disease [COPD] or congestive heart failure [CHF]) because of improved outcomes (ie, increased survival, shorter length of stay, and lower costs) compared with IMV [invasive mechanical ventilation]. As a result of the expanded use of NIV, use of IMV among these populations has substantially decreased over time. Use of NIV to improve survival has been established; however, its use has also been suggested to achieve palliation in persons … Read More

“After 2 decades of efforts relying largely on quality measurement and performance-linked payment incentives, we need new ideas and new conversations. As revealed by health care workers’ response to the Covid-19 pandemic, professionalism in health care may be an underused resource. Reframing quality improvement around the linchpin of care delivery — physician agency — could provide much-needed direction by elucidating strategies that address problems of information or motivation when professionals act as agents on their patients’ behalf. [..] A central concept in health economics is that the physician acts as an agent for the patient, determining what the patient’s problem … Read More

“The American College of Cardiology and American Heart Association (ACC/AHA) practice guidelines for perioperative cardiovascular evaluation for noncardiac surgery aim to improve the effectiveness of perioperative care, optimize patient outcomes, and improve resource use. The guidelines have consistently deemphasized preoperative cardiac testing prompted solely by the upcoming surgery in the absence of signs or symptoms that would warrant testing outside of the preoperative setting. [..] Using MarketScan inpatient claims data from 2003 to 2017, we selected patients according to International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM, … Read More

“Managing health care spending is critical considering that the U.S. health care economy exceeds $3.5 trillion. Between $760 billion and $935 billion is wasted on low-value care that costs considerably more than its clinical benefits are worth. Giving Equal Weight to Valuation of Health Care Services and Technologies [..] payer reimbursements for health care providers and biomedical manufacturers could not be more different. Medicare and other payers that adhere to Medicare payment structures use prospective payments based on diagnosis-related group for hospital services, and fee schedules based on relative value units for physician services. Payments have created a fundamental divide … Read More