Forum Focus – Appropriate Use of Medical Resources: Toolkits to Improve Care

In November 2013, the American Hospital Association’s Physician Leadership Forum (PLF) released “Appropriate Use of Medical Resources,” a white paper that identifies some of the drivers of health care utilization and its contributing factors. More importantly, the paper recommends a way to move forward that will place hospitals at the forefront of innovative change for reducing non-beneficial services while improving health care overall. The paper focuses on a “top five” list of hospital-based procedures or interventions that should be reviewed and discussed by a patient and physician prior to proceeding.

To support hospitals’ efforts in the appropriate use of medical resources, the PLF produced toolkits on each of these five recommended areas. Each toolkit contains dedicated sections for hospital and health system management, clinicians, and patients. Materials are available at www.aha.org/appropriateuse. Below is a brief look at the five topics targeted.

 

Patient Blood Management

Clinical research has shown that restrictive transfusion practices are generally associated with better patient outcomes as well as reduced health care resource utilization. A growing number of clinicians who order blood products are turning to patient blood management (PBM) as an important component of their care planning decisions. PBM comprises a variety of methods, such as the use of evidence-based transfusion guidelines as well as anemia and coagulation management.

The Patient Blood Management toolkit is composed of three sections:

  • Hospital and Health System Resources – Includes a readiness assessment tool, the starting point in developing a successful PBM model, as well as resources supporting the benefits of appropriate use of PBM, and frequently asked questions.
  • Clinician Resources – Includes a webinar, clinical evidence supporting appropriate use, implementation instructions, and an iPhone application.
  • Patient Resources – Includes a guide on how patients can best engage in their care.

Antimicrobial Stewardship

Antibiotics are one of the great discoveries in medicine and the most important weapon in fighting bacterial diseases. Infections that were once deadly can now be cured, and antibiotics have made many life-saving treatments possible. However, overuse and unnecessary use of antibiotics can lead to deadly antibiotic-resistant strains of bacteria and cause serious side effects. The Centers for Disease Control & Prevention reports that approximately half of all antibiotic prescriptions written are either unnecessary or used inappropriately.

The Antimicrobial Stewardship toolkit is composed of three sections:

  • Hospital and Health System Resources – Includes a readiness assessment tool, the starting point in developing or enhancing a successful Antimicrobial Stewardship Program (ASP). For ease of use, the tool is divided into two sections, one for those just beginning a program, the other for those who wish to enhance an existing program.
  • Clinician Resources – Includes webinars, clinical evidence supporting appropriate use of antibiotics, implementation guides and related articles.
  • Patient Resources – Includes frequently asked questions, pamphlets and handouts on how patients can best engage in their care and resources on appropriate use of antibiotics.

Ambulatory Care Sensitive Conditions

As resource-intensive settings, emergency department and inpatient hospital care need to be carefully monitored to ensure the most appropriate use. Significant research has shown that for several Ambulatory Care Sensitive Conditions (ACSCs) – low back pain, asthma, uncomplicated pneumonia – access to primary care, urgent care clinics, outpatient services, and other sub-acute settings can improve patient outcomes, reduce hospital admissions and readmissions, and lower costs. Reducing ACSC admissions requires understanding of the problem and a commitment to making change.

The ACSC toolkit is composed of three sections:

  • Hospital and Health System Resources – Includes guides, fact sheets, and resources supporting treatment of ambulatory care sensitive conditions.
  • Clinician Resources – Includes clinical evidence for management of specific ACSCs, frequently asked questions and a report on the impact of integrated care on preventing hospitalization.
  • Patient Resources – Includes action plans, frequently asked questions and resources for patients on how to best engage in their care and prevent hospitalizations for ACSCs.

Elective Percutaneous Coronary Intervention

According to the American College of Cardiology, American Heart Association, the Society for Cardiovascular Angiography and Interventions and other experts, immediate coronary angiography with percutaneous coronary intervention (PCI) is recommended for patients with ST elevation myocardial infarction (STEMI). Research has shown, though, for patients with non-acute coronary artery disease, PCI has little to no effect on outcomes. Appropriate use of PCI with the right patient at the right time can improve outcomes, reduce hospital admissions and readmissions and lower costs.

The Elective PCI toolkit is composed of three sections:

  • Hospital and Health System Resources – Includes quality improvement resources and links to the National Cardiovascular Data Registry®.
  • Clinician Resources – Includes mobile applications, guidelines and clinical evidence supporting the appropriate use of elective percutaneous coronary interventions.
  • Patient Resources – Includes resources to understand the best use of angioplasty and how to obtain the right tests and treatments.

Aligning Treatment with Patient Priorities in the Context of Progressive Disease for Use of the ICU

The most appropriate use of the intensive care unit (ICU) can improve outcomes, improve the care experience and lower costs. Hospital and health care systems should encourage early intervention and discussion about priorities for medical care in the context of progressive disease and robust communication between patients and their providers to understand patients’ preferences and goals. These discussions should address the likelihood of acceptable (to the patient) recovery, the risks, the options for palliative care co-management at the same time as disease-directed treatment and the benefits of hospice care, all in the framework of the patient’s priorities.

The ICU toolkit is composed of three sections:

  • Hospital and Health System Resources – Includes assessment guides, PowerPoint presentations, key statistics and findings, position statements and resources supporting the appropriate use of the ICU for patients near the end of their lives.
  • Clinician Resources – Includes fact sheets, a palliative care screen, tip sheets, communication guides, articles, a webcast and recommendations regarding end-of-life care in the ICU.
  • Patient Resources – Includes two overview pieces and resources regarding palliative care, advance care directives, and ICU/treatment-specific concerns for patients, their families and caregivers.
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