According to a recent Wall Street Journal (WSJ) article (subscription required), some hospitals across the country are attempting to reduce costs by standardizing care. They do this by encouraging physicians to follow national, evidenced-based guidelines on how to best treat different diseases. The article notes that while professional medical organizations, such as the American Hospital Association (AHA), publish such guidelines, doctors often deviate from them because of personal preference, fear of patient lawsuits, or institutional customs, among other things. This may result in overuse of certain tests and procedures.
The article highlights Delaware’s Christiana Care Health System, which changed its computer system to encourage doctors to follow AHA guidelines for using cardiac monitors for non-ICU (intensive care) patients. It did so by removing the option to order monitoring for conditions that were not AHA-approved, which required physicians to complete an extra step if they still wished to order the monitoring for non-approved conditions. In addition, for AHA-approved conditions, the computer system attached a fixed, recommended time period to complete the monitoring. If a patient remained in the hospital after the time period elapsed, nurses were required to stop the monitoring, unless it was believed to be unsafe.
A study published in JAMA Internal Medicine found that the number of non-ICU patients using the monitors and the hospital group’s daily monitoring costs decreased 70% without any negative effects on patient care.
The WSJ article notes that the movement towards standardized patient care is challenged by many physicians who (1) want additional evidence to support this movement or (2) believe that they should not consider cost as a primary factor when providing patient care.
