Today, there is a stark gap between the expectation of healthcare delivery and the reality, said Dr Denise Basow, CEO of Clinical Effectiveness at Wolters Kluwer, a provider of solutions that help healthcare organizations and professionals harmonize care and reduce unwanted variability by aligning care team decisions.
And this gap is “causing wasted resources, and missed opportunities” for hospitals, she noted recently. One term for this phenomenon is “unwanted variability in care”, where patients receive inconsistent levels of care based on the seemingly arbitrary choice of which hospital or clinic to visit.
What’s more, the real problem with unwanted variability in care is “it’s expensive, and it leads to low quality care”. Some have even described this problem as “the greatest threat to healthcare”, Basow remarked at the recent Clinical Effectiveness CEO Summit on 29 August, presented by Hospital Insider and Wolters Kluwer.
In Asia Pacific, there are sobering statistics: in Japan, for instance, the lowest case fatality rate of any hospital is 12.2 percent. At the same time, in Australia, it is 4.1 percent. But “there is no reason that this needs to be this way”, Basow emphasised. There aren’t any particular factors in either country that is contributing to this difference; it is “all about the care being delivered”.
In Malaysia1, unnecessary tests and waste eat up an estimated 30 percent of healthcare costs. Meanwhile, in Korea, unnecessary hospitalisations and surgeries make up 20 percent of medical expenses, Basow continued.
When it comes to medication errors, the numbers keep ballooning. A study of OECD countries found that almost a quarter of patients receive inappropriate prescriptions, costing this group around $42 billion2 – or 1 percent of total healthcare spending . What is worse, these errors lead to patient deaths in some cases, Basow noted. “You can do a lot of six sigma and lean processes in your hospital, but at some point, you have to begin addressing the clinical care that is being delivered.”
Part of the problem lies in the sheer amount of medical literature that doctors have to keep up with. No one human is equipped to read it all. And “even if physicians can keep up with the medical literature in their particular specialty, it’s not always easy to interpret what’s going on”, Basow pointed out.
At Wolters Kluwer, more than 6,900 physician authors, editors, and peer reviewers, sift through these journals, articles and research, creating evidence based content that provides recommendations to help care teams make evidence-based decisions for patients. “Now, we have more than 10,000 graded recommendations within UpToDate,” said Basow. “For the vast majority of the decisions that clinicians are making everyday, there’s high risk for clinical variation, as the evidence isn’t always clear. And that’s quite a difficult situation, unless we help clinicians make those decisions.”
A Singapore University hospital recently conducted a study which emphasised the importance of evidence-based medicine: “They looked at the decision making of physicians who used UpToDate, and found that when they access UpToDate, they ended up changing a clinical decision about 37 percent of the time,” Basow explained. Other studies show that up to 40 percent of the time, evidence-based medicine helps change decisions.
A more informed decision by clinicians can lead to better outcomes, Basow continued. “According to one study, there were significant improvements in all the quality measures observed in hospitals that adopted UpToDate – and an association with shorter lengths of stay, and improved mortality rates.”
Harmonised care is the way forward for addressing unwanted care variability. This means that physicians are no longer at the centre of the healthcare world, surrounded by siloed care teams. Rather, patients should be “in the centre of the healthcare universe”, and aligned care teams make decisions in a consistent, evidence-based manner, at exacting standards every time. “My aspiration is that we truly begin to harmonise care,” Basow concluded.
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1 Sources: The Australian; NCBI; YonhapNews; The Star; Ministry of Health, Singapore
2 Sources: World Health Organization; Maggioni, A. P., Gool, K. V., Biondi, N., Urso, R., Klazinga, N., Ferrari, R., . . . Tavazzi, L. (2015). Appropriateness of Prescriptions of Recommended Treatments in Organisation for Economic Co-operation and Development Health Systems: Findings Based on the Long-Term Registry of the European Society of Cardiology on Heart Failure. Value in Health, 18(8), 1098-1104. doi:10.1016/j.jval.2015.08.005