Quality Quest for Health of Illinois
Healthcare Reform
We know the healthcare system has problems and that reform is needed on both the national and local levels. But what reforms will have the biggest impact?
Evidence-based medicine
Encouraging physicians to practice evidence-based medicine and follow guidelines is a start. Guidelines such as those from the Institute for Clinical Systems Improvement (ICSI) focus on practicing medicine based on science and information—a model that provides patients with beneficial outcomes and minimal risk for harm. Following standard ways of practicing medicine results in more effective outcomes and lets us determine how often we deliver the right care. Other business practices commonly follow standards. You wouldn't buy a car if the manufacturer didn't put a steering wheel inside! Why would you want medical care that didn't follow established guidelines?
Preventive medicine
Focusing on preventive medicine instead of waiting to treat disease after it develops is another step. The cost of treating cancer, heart disease, diabetes and other illnesses rises as the disease progresses. Preventive screenings can find indicators of disease early so that it can be managed or avoided. Early detection and prevention save thousands of lives each year, and preventive medicine improves the overall health of the population.
Performance reporting
Reporting the performance of doctors and hospitals is another important step on the path to reform. If we measure how well providers follow care guidelines and improve their patients' health, this information can be shared with consumers. Patients can see how their provider compares to other providers, and doctors and hospitals can compare their performance to peers and see how they match up. This helps providers evaluate their services and look for areas to improve patient care.
Payment system
High healthcare costs are a problem that can be fixed, in part, by changing the payment system. Payment that is centered on the quality of care works well in conjunction with reporting provider performance. In all of medicine, there are thousands of billing codes for procedures that healthcare professionals perform. Yet even with all these codes, there is not a single billing code for improving a patient's health.
Our system has made it standard to pay for the number of services that are provided, regardless of whether the patient's condition improves. This can lead to doctors and providers giving extra care that isn't necessary, either to increase their profit or because they fear malpractice suits from not doing enough. Changing the payment system to pay based on patient outcome can fix these problems and decrease healthcare costs.
Record-keeping
Medical record-keeping needs reform to match the ever-increasing advances in technology. There is legitimate concern over electronic records being stolen or being misused to deny care or coverage to patients; however, record-keeping programs provide strong security and reform in this area will eliminate discrimination based on pre-existing conditions.
Paper records are outdated and can be improved upon by switching to electronic medical records, which provide great benefits to patients and providers. If a patient wants or needs to change providers, a new provider can access the patient's medical charts and history, saving a lot of time and money and avoiding duplication.
Waste
Eliminating waste from medical care is an important reform that could reduce a third of the total cost of healthcare. Waste comes in three different forms—overuse, underuse and misuse. Overuse includes people getting care that they do not need or that is not beneficial to them, such as visiting the emergency room for non-emergency situations or getting prescription antibiotics for colds or flu symptoms. Underuse means not giving patients care that could help them. For example, medications that help people control their blood pressure and cholesterol lower the risk of future problems with heart disease. Misuse of care results in preventable infections in hospitals, errors in medications, and other problems that increase costs. Removing waste from healthcare is not easy, but is a necessity.
Healthcare Burning Platform
Evidence is information that is used to determine or demonstrate the truth of an assertion. In the field of health, Evidence is collected in an orderly way to help us understand what to do. This information can come from medical research.
Evidence is information that is used to determine or demonstrate the truth of an assertion. In the field of health, Evidence is collected in an orderly way to help us understand what to do. This information can come from medical research.
A Provider is a professional engaged in the delivery of health services, including physicians, dentists, nurses, podiatrists, optometrists, clinical psychologists, etc. Hospitals and long-term care facilities are also Providers. The Medicare program uses the term "Provider" more narrowly, to mean participating institutions: hospitals, skilled nursing facilities, home health agencies, etc.
A Provider is a professional engaged in the delivery of health services, including physicians, dentists, nurses, podiatrists, optometrists, clinical psychologists, etc. Hospitals and long-term care facilities are also Providers. The Medicare program uses the term "Provider" more narrowly, to mean participating institutions: hospitals, skilled nursing facilities, home health agencies, etc.
Outcome is the result of a process, including outputs, effects and impacts.
Benefits are what insurance pays to cover consumer health services. A Benefits package specifies what services and products an insurance plan will pay for and plans typically offer several different benefit packages at different costs. The word "Benefits" can also mean the good results of a treatment or lifestyle change.
A Provider is a professional engaged in the delivery of health services, including physicians, dentists, nurses, podiatrists, optometrists, clinical psychologists, etc. Hospitals and long-term care facilities are also Providers. The Medicare program uses the term "Provider" more narrowly, to mean participating institutions: hospitals, skilled nursing facilities, home health agencies, etc.
Overuse describes a process of care in circumstances where the potential for harm exceeds the potential for benefit. Prescribing an antibiotic for a viral infection like a cold, for which antibiotics are ineffective, constitutes Overuse. The potential for harm includes adverse reactions to the antibiotics and increases in antibiotic resistance among bacteria in the community. Overuse can also apply to diagnostic tests and surgical procedures.
Underuse refers to the failure to provide a health care service when it would have produced a favorable outcome for a patient. Standard examples include failure to provide appropriate preventive services to eligible patients (e.g., Pap smears, flu shots for elderly patients, screening for hypertension) and proven medications for chronic illnesses (steroid inhalers for asthmatics; aspirin, beta-blockers and lipid-lowering agents for patients who have suffered a recent myocardial infarction).
Misuse occurs when an appropriate process of care has been selected, but a preventable complication occurs and the patient does not receive the full potential benefit of the service. Avoidable complications of surgery or medication use are Misuse problems. A patient who suffers a rash after receiving penicillin for strep throat, despite having a known allergy to that antibiotic, is an example of Misuse. A patient who develops a pneumothorax after an inexperienced operator attempted to insert a subclavian line would represent another example of Misuse.
Overuse describes a process of care in circumstances where the potential for harm exceeds the potential for benefit. Prescribing an antibiotic for a viral infection like a cold, for which antibiotics are ineffective, constitutes Overuse. The potential for harm includes adverse reactions to the antibiotics and increases in antibiotic resistance among bacteria in the community. Overuse can also apply to diagnostic tests and surgical procedures.
Underuse refers to the failure to provide a health care service when it would have produced a favorable outcome for a patient. Standard examples include failure to provide appropriate preventive services to eligible patients (e.g., Pap smears, flu shots for elderly patients, screening for hypertension) and proven medications for chronic illnesses (steroid inhalers for asthmatics; aspirin, beta-blockers and lipid-lowering agents for patients who have suffered a recent myocardial infarction).
Misuse occurs when an appropriate process of care has been selected, but a preventable complication occurs and the patient does not receive the full potential benefit of the service. Avoidable complications of surgery or medication use are Misuse problems. A patient who suffers a rash after receiving penicillin for strep throat, despite having a known allergy to that antibiotic, is an example of Misuse. A patient who develops a pneumothorax after an inexperienced operator attempted to insert a subclavian line would represent another example of Misuse.
