Doctors as Resource Stewards? Translating High-Value, Cost-Conscious Care to the Consulting Room

Moleman, Marjolein; Zuiderent‐Jerak, Teun; Lageweg, Marianne; Braak, Gianni L. van den; Schuitmaker-Warnaar, Tjerk Jan

doi:10.1007/s10728-022-00446-4

Cited by 5 publications

(3 citation statements)

References 46 publications

(54 reference statements)

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“…Reflecting one of the few previous studies in this area with medical students, albeit in the US context, our participants acknowledged the that physicians have a duty to contain costs yet their own clinical decisions are influenced by the fear of potential malpractice risks and what they see others do [43]. Some of the barriers identified reflect those found in previous studies with residents [44,45] and fully-trained staff [46,47], and in other contexts [48,49]. Nevertheless, our theory driven analysis added value in that it facilitated a richer exploration of why students do not consider cost in clinical decision making.…”

Section: Comparison With Previous Literaturementioning

confidence: 82%

‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

Tan,

Ng,

Soh

et al. 2023

BMC Med Educ

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Context Cost-conscious care is critical for healthcare sustainability but evidence suggests that most doctors do not consider cost in their clinical decision making. A critical step in changing this is understanding the barriers to encouraging behaviours and attitudes related to cost-conscious care. We therefore conducted a qualitative study to address the research question: what factors influence consideration of cost in emergency medicine (ED) clinical decision making? Methods This was a qualitative focus group study using patient vignettes to explore attitudes towards cost-conscious clinical decision making. Participants were Year 4 and Year 5 medical students from Singapore, a country with a fee-for-service healthcare system. After a data-driven initial data analysis, and to make sense of a multitude of factors impacting on cost conscious care, we selected Fishbein’s integrative model of behavioural prediction to underpin secondary data analysis. Results Via four focus groups with 21 participants, we identified five main themes relevant to the integrative model of behavioural prediction. These were: attitudes towards considering cost when managing a patient (e.g., “better safe than sorry”); normative beliefs (e.g., doing what others do, perceptions of patient wishes); efficacy beliefs (e.g., no authority to take decisions or challenge); skills and knowledge (e.g., little knowledge of costs), and environmental constraints (e.g., the nature of the healthcare system). Discussion Medical students do not consider cost in their clinical decision making due to numerous factors, of which lack of knowledge of costs is but one. While some of the factors identified reflect those found in previous studies with residents and fully-trained staff, and in other contexts, theory driven analysis added value in that it facilitated a richer exploration of why students do not consider cost in clinical decision making. Our findings provide insight to inform how best to engage and empower educators and learners in teaching and learning about cost-conscious care.

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Section: Comparison With Previous Literaturementioning

confidence: 82%

‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

Tan,

Ng,

Soh

et al. 2023

BMC Med Educ

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“…Hun keuzes en beslissingen zijn daardoor medebepalend voor hoe we schaarse middelen in de zorg inzetten. Daardoor worden zorgprofessionals meer en meer gezien als 'zorgstewards' [28], zeg maar als diegene die moeten gaan zorgdragen voor een verantwoord gebruik van schaarse middelen in de zorg. Een verantwoord gebruik wordt daarbij steeds meer geassocieerd met kostenbewuste zorg [29][30][31].…”

Section: Figuur 3 Preventie 'Ongezond' €-Gedrag Zorgaanbiedersunclassified

Bewust op weg naar doelmatigheid van zorg en onderwijs

Paulus

2022

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“…In practice, data science has emerged as a powerful tool in healthcare, revolutionizing the way medical decisions are made and HSPs are managed (21,33,34). Data-driven approaches allow hospitals to identify subpopulations that would benefit the most from personalized medicine, thus addressing the challenge of resource scarcity (35)(36)(37).…”

Section: Introductionmentioning

confidence: 99%

Investigation toward the economic feasibility of personalized medicine for healthcare service providers: the case of bladder cancer

Savchenko,

Bunimovich-Mendrazitsky

2024

Front. Med.

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In today's complex healthcare landscape, the pursuit of delivering optimal patient care while navigating intricate economic dynamics poses a significant challenge for healthcare service providers (HSPs). In this already complex dynamic, the emergence of clinically promising personalized medicine-based treatment aims to revolutionize medicine. While personalized medicine holds tremendous potential for enhancing therapeutic outcomes, its integration within resource-constrained HSPs presents formidable challenges. In this study, we investigate the economic feasibility of implementing personalized medicine. The central objective is to strike a balance between catering to individual patient needs and making economically viable decisions. Unlike conventional binary approaches to personalized treatment, we propose a more nuanced perspective by treating personalization as a spectrum. This approach allows for greater flexibility in decision-making and resource allocation. To this end, we propose a mathematical framework to investigate our proposal, focusing on Bladder Cancer (BC) as a case study. Our results show that while it is feasible to introduce personalized medicine, a highly efficient but highly expensive one would be short-lived relative to its less effective but cheaper alternative as the latter can be provided to a larger cohort of patients, optimizing the HSP's objective better.

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Doctors as Resource Stewards? Translating High-Value, Cost-Conscious Care to the Consulting Room

Cited by 5 publications

References 46 publications

‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

‘But what if you miss something …?’: factors that influence medical student consideration of cost in decision making

Bewust op weg naar doelmatigheid van zorg en onderwijs

Investigation toward the economic feasibility of personalized medicine for healthcare service providers: the case of bladder cancer

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