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Engaging patients in their care leads to better decision-making

February 22, 2013


 

 In just one week, the sequester – the sharp, automatic spending cuts that include a 2Medical knowledge has increased exponentially in the last decades and clinical knowledge doubles as fast as every two years. Cutting-edge surgeries, cures for once-devastating diseases, and tools to manage chronic illness have all been great boons to society, allowing longer, more productive lives. But with all this knowledge looms a larger debate, when are we doing too much and how do we decide?

Several decades ago, utilization review was as essential to health care discussions as quality and patient safety are today, but as it became synonymous with costcutting, there has been less vigorous review of appropriateness. However, health care resources are finite; if we don’t explicitly manage them, we will likely increase care disparities.

As health care becomes more complex and technology-driven, it is important that we not fall under the spell of over-diagnosing and treating those things that have no clinical consequence and might benefit from watchful waiting or less aggressive interventions. Care providers endeavor to provide the most appropriate care to patients regardless of cost, but all too often there isn’t enough discussion about what is appropriate. Will this test or procedure impact appropriate care, and is it in the best interest of the patient? And, further, how can the health care system equip patients to participate in those decisions?

In April 2012, the American Board of Internal Medicine Foundation launched the Choosing Wisely campaign, lists of five common procedures or tests whose necessity should be questioned and discussed by patients and their physicians. According to their research, 5% of the U.S. gross national product is spent on tests and procedures that do not improve patient outcomes.

The lists, outlined by several specialties, create a structure for patients and physicians to discuss the appropriateness of certain interventions.

Allowing patients the chance to decide for themselves, in consultation with their physician, what procedures and tests best fit their needs can help ensure that resources are used appropriately.

In addition, these types of conversations might reduce some of the unnecessary care that may result from increasingly sensitive testing.

As recent studies have shown, while the incidence of several cancer diagnoses has increased, there hasn’t been a corresponding drop in their mortality, so more people are living with a cancer diagnosis and, more importantly, receiving cancer treatments that may not impact their survival but could reduce their quality of life.

What role can hospitals play in providing a structure for patients and their health care providers to have meaningful conversations about appropriate use of care? Better decision-making leads to higher- quality care and involving patients in their care decisions can improve their satisfaction and lead to improved outcomes.

As one of the more intense resource users, hospitals have a responsibility to look for ways to guide appropriate and consistent use of health care and provide tools for health care providers to better communicate with patients around appropriate care.

As we navigate from a feefor- service system to a valuebased era, wise use of resources to provide appropriate care is essential.

Combes is an AHA senior vice president. Arespacochaga is director of the AHA’s Physician Leadership Forum. On the issue of engaging patients in their care, the AHA’s Committee on Research recently released a report on how hospitals, patients and family members can forge a true partnership as members of the health care team. Learn more by clicking on: http://tinyurl.com/b27n5te.

By John R. Combes, M.D., and Elisa Arespacochaga