What Rate of Utilization is Appropriate in Musculoskeletal Care?
AUTOR(ES)
Lurie, Jon D.
FONTE
Springer-Verlag
RESUMO
Musculoskeletal procedures often show wide variation in rates across geographic areas, which begs the question, “Which rate is right?” Clearly, there is no simple answer to this question. We summarize a conceptual framework for thinking about how to approach this question for different types of interventions. One guiding principle is the “right rate” is usually the one that results from the choices of a fully informed and empowered patient population. For truly effective care without substantial tradeoffs, the right rate may approach 100%. The rate of operative treatment of hip fracture, for example, approaches the underlying incidence of disease; however, the rate of some forms of effective care, like osteoporosis evaluation and treatment after a fragility fracture, is often quite low and undoubtedly reflects underuse. The recommended approach to underuse is to improve the reliability and accountability of the delivery system. Many other musculoskeletal interventions fall into the category of “preference-sensitive care.” These interventions involve important tradeoffs between risks and benefits. Variations in these procedure rates may represent insufficient focus on patient values and preferences, relying instead on the enthusiasm of the physician for treatment alternatives. The recommended approach in this setting is the use of decision aids and other approaches to informed choice.
ACESSO AO ARTIGO
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2745463Documentos Relacionados
- What next for electronic communication and health care?
- How important is continuity of care?
- What do we mean by appropriate health care? Report of a working group prepared for the Director of Research and Development of the NHS Management Executive.
- Identification and management of familial hypercholesterolaemia: what does it mean to primary care?
- Is succinylcholine appropriate or obsolete in the intensive care unit?