Inappropriate Use of Resources
Over the past two decades, healthcare costs have increased dramatically, year over year, with little discernible improvement in outcomes. The “try everything” approach is not sustainable, which is why medical societies and associations have worked collaboratively to author appropriate use criteria.
The topic can be contentious, admittedly. It forces providers to contemplate who, what, where, when, why and how. Nevertheless, healthcare organizations have a collective responsibility to encourage and monitor the appropriate use of resources, and to adapt policies and procedures accordingly. Long-term financial viability is at stake, especially in light of risk-bearing and value-based arrangements.
Using ePRISM® predictive content solutions to determine whether resources are ‘appropriate,’ ‘may be appropriate’ or ‘rarely appropriate’ supports greater concordance with established criteria and more cost-effective care, and allows clinicians to document decision rationale.
Best Practices That Don’t Incorporate Real-Time, Patient-Specific Risks
Performing in a manner consistent with industry standards and best practices is intended to produce reliable, high-quality care. Unfortunately, industry standards and best practices are designed to address broad populations of patients and heterogeneity of care centered around diagnoses or treatments, which does little to address individualized patient risk and other nuances.
Scientific evidence proves that the probability of a good versus bad outcome, i.e., a patient most likely to benefit versus a patient least likely to benefit, can in many situations be traced to a very discrete set of determinants.
By introducing real-time measurements of patient risk, our ePRISM® predictive content solutions allow clinicians to practice personalized medicine that marries industry standards and best practices with evidence-based outcome determinants.
Performance Inconsistent with Registry Benchmarks
State and national registries are abundant, addressing areas of medicine from cardiology, oncology and ophthalmology to orthopaedics, vascular surgery, bariatrics and beyond. By aggregating datasets across large numbers of organizations, registries are able to furnish in-depth outcomes analysis and comparative benchmarking no healthcare provider or payer can produce on its own.
The downfall is, organizations that participate in registries are not well equipped to effect change and improvement in areas for which the analysis and benchmarking indicate shortcomings. The best they can accomplish is the creation or modification of protocols for affected patient populations.
The prospective nature of ePRISM® is a perfect complement to the retrospective nature of registries, offering clinicians real-time risk, appropriate use and other predictive measurements, and giving them the ability to tailor clinical decisions at the individual patient level.
Patient Documents Incompatible with Shared Decision-Making
Most consent documents are written in legalese that is both vague and difficult to understand. Coupled with generic educational materials, patients have little basis for comprehending the risks and benefits associated with a specific course of treatment. At best, they learn what may happen to somebody (anybody) with the same condition or diagnosis.
Shared decision-making is proven most favorable when patients are given information unique to their individual circumstance, and are not overwhelmed by cryptic, nonspecific details that cause confusion and angst.
ePRISM® offers personalized, graphically-rich consent documents and educational materials, written at an 8th-grade level, that aid shared decision-making by fostering a deeper understanding of risks and/or benefits while enhancing overall patient satisfaction and peace of mind.
No Uniform Set of Measures for Observed vs Expected Outcomes
Clinicians typically have ready access to guidelines and clinical decision support content, but not a uniform set of measures that indicate observed versus expected treatment outcomes or recovery. For example, they can communicate when it may be typical, give or take, for the average patient to recover full range of motion following a knee replacement, or the ability to play a sport following heart surgery, but nothing specific to the individual patient.
A means to reconcile observed versus expected treatment outcomes or recovery at a defined point in time — or for a defined period of time — creates a considerable advantage in clinicians’ ability to make effective, patient-centric decisions around follow-up care and referrals.
Several content solutions available through ePRISM® compute prospective baseline measures as well as continued follow-up measures, allowing clinicians the ability to longitudinally gauge observed versus expected outcomes or recovery, and to respond accordingly.
Providers Lack Ability to Triage, Refer and Manage High-Acuity Patients
When is it appropriate to arrange an ICD or CRT evaluation for a patient with heart arrhythmia? If a patient has a family history of breast cancer, under what conditions is a breast MRI warranted? Is it okay to prescribe an anticoagulant for a patient with atrial fibrillation?
These types of questions can prove challenging for primary care physicians and specialists alike, who tend to make decisions for high-acuity patients based mostly on concern that lack of “doing everything possible” will result in a preventable catastrophic event.
The risk, appropriate use and other predictive measurements available through ePRISM® can support clinical decisions made in ambulatory settings, and are especially helpful when seeking to properly triage, refer and manage high-acuity patients.