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This title deals with internationally documented variations in medical practice and health service that exist across countries as well as regions across a specific country. Such variations raise critical concerns about the quality, equity and efficiency of health care resources across the world. Health services researchers have long been aware of large variations in the use of medical care across regions and medical providers. In the 1930s, the British pediatrician J.A. Glover observed that the rates of tonsillectomy in British schoolchildren varied widely, depending on the district where the students lived and the doctors who examined them. This volume provides a contextual landscape for the study of health care utilization through the lens of medical practice variations. It is grounded in the pioneering work by medical care epidemiologist, Dr. John Wennberg, who revealed wide variations in elective surgical rates across small areas in the U.S. and his findings that these variations were generally not explained by differences in population illness rates or patient preferences but rather, there were strong associations between supply of health care resources, such as hospital beds and physicians and health care utilization. This volume introduces the concept of medical practice variations and its early history, outlines established concepts and frameworks, with an overview of methods used to understand the variations in medical care . It makes the case for outcomes research in determining what works in health care and policy reforms to rationalize how care is delivered. Each chapter synthesizes the current published literature in the field and covers a description of medical practice variations in the area, determinants of these variations and outcomes. It outlines the most current research on specific types of utilization such as inpatient care, emergency services, elective surgery, primary care, obstetric and gynaec ological care, mental health care and end-of-life care, among others. Studies of variation in condition-specific care focus on common conditions such as acute myocardial infarction, congestive heart failure, stroke, diabetes and procedures such as cancer surgery and joint replacement. Special topics include health care spending and quality, shared decision making and disparities.
In recent years it has become very clear that there are considerable differences, both across countries and within countries, in the treatments offered by doctors to apparently similar patients. The Challenges of Medical Practice Variations discusses and examines a number of variations in practice: why they exist, their implications for effectiveness, efficiency and equity; and what should be done about them in terms of both health policy and research. This book sees such practice variations as a challenging and promising stepping-stone towards a necessary reassessment of today's, and tomorrow's, health services. A major cross-disciplinary effort is called for, and the authors, with their diverse backgrounds, provide the necessary components for just such an effort. The book will be of value not only to health economists. It has been written primarily to appeal to other healthcare professionals and students, and introduces key elements of current thinking on medical practice variations.
This report helps policy makers better understand the issues and challenges around geographic variations in health care provision and considers the policy options.
Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
Western medicine is widely thought of as a coherent and unified field in which beliefs, definitions, and judgments are shared. This book debunks this myth with an interdisciplinary and intercultural collection of essays that reveals the significantly varied ways practitioners of "conventional" Western medicine handle bodies, study test results, configure statistics, and converse with patients.
Every day we make decisions about our health - some big and some small. What we eat, how we live and even where we live can affect our health. But how can we be sure that the advice we are given about these important matters is right for us? This book will provide you with the right tools for assessing health advice.
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
As the population of older Americans grows, it is becoming more racially and ethnically diverse. Differences in health by racial and ethnic status could be increasingly consequential for health policy and programs. Such differences are not simply a matter of education or ability to pay for health care. For instance, Asian Americans and Hispanics appear to be in better health, on a number of indicators, than White Americans, despite, on average, lower socioeconomic status. The reasons are complex, including possible roles for such factors as selective migration, risk behaviors, exposure to various stressors, patient attitudes, and geographic variation in health care. This volume, produced by a multidisciplinary panel, considers such possible explanations for racial and ethnic health differentials within an integrated framework. It provides a concise summary of available research and lays out a research agenda to address the many uncertainties in current knowledge. It recommends, for instance, looking at health differentials across the life course and deciphering the links between factors presumably producing differentials and biopsychosocial mechanisms that lead to impaired health.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.