Best Care at Lower Cost

Smith, Mark H.; Saunders, R. S.; Stuckhardt, Leigh; McGinnis, J. Michael

doi:10.17226/13444

Cited by 83 publications

(26 citation statements)

References 488 publications

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“…The World Health Organization reports that thousands of people are affected by complications and adverse events (AEs) associated with caregiving, and that these events increase morbidity and mortality rates worldwide [1][2][3]. Complications in hospital are unfortunate for patients and expensive for healthcare systems [4].…”

Section: Introductionmentioning

confidence: 99%

Care complexity individual factors associated with adverse events and in-hospital mortality

et al. 2020

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Introduction Measuring the impact of care complexity on health outcomes, based on psychosocial, biological and environmental circumstances, is important in order to detect predictors of early deterioration of inpatients. We aimed to identify care complexity individual factors associated with selected adverse events and in-hospital mortality. Methods A multicenter, case-control study was carried out at eight public hospitals in Catalonia, Spain, from January 1, 2016 to December 31, 2017. All adult patients admitted to a ward or a step-down unit were evaluated. Patients were divided into the following groups based on the presence or absence of three adverse events (pressure ulcers, falls or aspiration pneumonia) and in-hospital mortality. The 28 care complexity individual factors were classified in five domains (developmental, mental-cognitive, psycho-emotional, sociocultural and comorbidity/complications). Adverse events and complexity factors were retrospectively reviewed by consulting patients' electronic health records. Multivariate logistic analysis was performed to identify factors associated with an adverse event and in-hospital mortality. Results A total of 183,677 adult admissions were studied. Of these, 3,973 (2.2%) patients experienced an adverse event during hospitalization (1,673 [0.9%] pressure ulcers; 1,217 [0.7%] falls and 1,236 [0.7%] aspiration pneumonia). In-hospital mortality was recorded in 3,996 patients (2.2%). After adjustment for potential confounders, the risk factors independently associated with both adverse events and in-hospital mortality were: mental status impairments, impaired adaptation, lack of caregiver support, old age, major chronic disease, hemodynamic instability, communication disorders, urinary or fecal incontinence, vascular

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Section: Introductionmentioning

confidence: 99%

Care complexity individual factors associated with adverse events and in-hospital mortality

et al. 2020

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“…Similar to other studies, this study demonstrated that fewer than 30% of primary care providers conduct interventions in direct contradiction to Choosing Wisely Canada recommendations. [1][2][3][4][5] Since the burden of unnecessary testing and treatment is not equally distributed, strategies designed to reduce unnecessary care could target specific provider and patient groups. Our modelling showed that each of the 4 testing and prescribing recommendations we asssessed were associated with different provider and patient characteristics.…”

Section: Discussionmentioning

confidence: 99%

Prescribing and testing by primary care providers to assess adherence to the Choosing Wisely Canada recommendations: a retrospective cohort study

Singer

Kosowan

Katz

et al. 2018

cmajo

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E vidence suggests that 20%-30% of total health care spending is associated with unnecessary care. 1-4 In 2014, the Choosing Wisely Canada campaign launched, encouraging patients and providers to reduce nonrecommended interventions. 5 Choosing Wisely Canada promotes recommendations developed by professional societies from 47 different specialties. 5 The recommendations relevant to primary care relate to judicious prescribing and laboratory testing to reduce harm or interventions that do not benefit patients. Two recommendations related to prescribing practices are about unnecessary prescribing of antibiotic 6 and antipsychotic 7 medication. Viral illnesses (e.g., acute sinusitis, bronchitis) do not respond to antibiotic treatment. Unnecessary prescribing of antibiotics puts patients at risk of adverse events, including allergic reactions and increased bacterial resistance. 6,8-12 Similarly, there is strong evidence demonstrating that antipsychotics should be used judiciously for the treatment of behavioural and psychological symptoms of dementia; they can increase the risk of premature death and adverse events such as cardiovascular effects. 7,13-16

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“…In 2012 the Institute of Medicine (IOM) published a 382 page report [1] that said medicine needs to be "anchored on patient needs and perspectives." That's pretty much the opposite of telling patients to comply with doctor's orders!…”

Section: Consider Thismentioning

confidence: 99%

The Patient's Perspective: Medicine's New True North

deBronkart¹

2016

PLAID

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Best Care at Lower Cost

Cited by 83 publications

References 488 publications

Care complexity individual factors associated with adverse events and in-hospital mortality

Care complexity individual factors associated with adverse events and in-hospital mortality

Prescribing and testing by primary care providers to assess adherence to the Choosing Wisely Canada recommendations: a retrospective cohort study

The Patient's Perspective: Medicine's New True North

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