Using computed tomography coronary angiography to evaluate patients with acute chest pain: putting the horse before the cart

Scott, Ian A

doi:10.1111/j.1445-5994.2011.02554.x

Cited by 2 publications

(2 citation statements)

References 28 publications

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“…Examples of premature adoption of new technologies include endovascular intervention in acute stroke, 34 use of CT coronary angiography 35 and high-sensitivity cardiac troponin assays 36 in assessment of acute chest pain and renal denervation in treatment-resistant hypertension. 37 Another problem is 'indication creep', whereby proof-of-benefit in selected patient groups is extrapolated uncritically to a wider spectrum of patients.…”

Section: Defer the Use Of Unproven Interventionsmentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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Section: Defer the Use Of Unproven Interventionsmentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

View full text Add to dashboard Cite

show abstract

“…The recent Medicare reimbursement of coronary computed tomographic angiography (CCTA) reflects the potential of this technology to result in significant cost‐savings and improved management of patients with coronary artery disease, including those presenting to the emergency department (ED) with chest pain. In his recent editorial, Scott 1 expresses concerns that CCTA is a ‘new test with possible unchartered hazards’, and implies that the use of CCTA in evaluating acute chest pain is a premature application of this technology.…”

mentioning

confidence: 99%