A Framework for Evaluating Value of New Clinical Recommendations

Abstract

To help stem ever increasing health care costs, clinicians, administrators, payors, and families must better communicate about the value of care options. Our institution sought to create a value analysis framework, based on local implementation of over 50 clinical pathways.From January to March 2015, a multidisciplinary team of clinicians, nursing, pharmacy, informatics, and analytics developed a cost dashboard, and a value analysis and decision-making framework. We reviewed all clinical pathway recommendations and measures, and examined issues related to implementing pathways. We examined specific line item costs for each pathway patient population.Our value analysis and decision-making framework is based upon 3 population-level comparisons: operational factors/ implementability, benefits, and costs/complications. We used the framework to scope new projects, to better target clinical recommendations, and to evaluate pathways postimplementation. From April through December 2015, we used this framework to prospectively analyze 19 pathway improvement proposals. The tool helped us to identify 16 improvements to implement (15 predicted to save costs), as well as identifying challenges facing 3 additional improvements.The value analysis and decision-making framework helps to ensure clinical recommendations are evaluated more broadly than just from a cost perspective. Systematic evaluation using this framework can improve populationbased decision-making. More research is needed in how to ensure that value analysis is performed to guide sustainable implementation of recommendations locally, and how to identify other institutions that may benefit from replicating successful implementations, so that the highest value care can be provided to patients everywhere.

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