Pick your outcomes battles carefully
Pick your outcomes battles carefully
Focused intervention reaps benefits
To get the most out of programs to improve outcomes, health plans and physicians should focus on interventions that are underused but proven effective, says Nelson Braslow, MD, national medical director of United HealthCare, in Hartford, CT.
While some therapies may have a complex array of risks and benefits, and some research produces contradictory results, a number of successful interventions have been identified and are being promoted through partnerships of physicians, professional societies, and health plans.
"You can identify situations that have significant health importance, that have reasonable frequency, that there is an identified best practice for the intervention," says Braslow.
"There should be an agreement on the part of the patient and the physician that the intervention is acceptable," he adds. "It has to be something potentially achievable and acceptable."
One example of such an intervention is the use of beta blockers after acute myocardial infarction. A recent study funded by the Rockville, MD-based Agency for Health Care Policy and Research reported that patients who receive beta blockers after a heart attack have 43% lower mortality within two years than those who do not. Only 21% of eligible patients receive beta blocker therapy, the study found.1
The study also showed substantial benefits of using beta blockers for patients over age 75. The National Committee for Quality Assurance in Washington, DC, used the findings to expand its outcomes performance measure related to beta blocker use in the Health Plan Employer Data and Information Set (HEDIS) 3.0.
A study by United HealthCare’s center for Health Care Policy and Evaluation in Minneapolis also found an underuse of beta blocker therapy, as well as use of beta blockers in patients with contraindicating conditions. In response, United HealthCare-affiliated health plans set up education programs and reminder letters for cardiologists treating post-myocardial infarction patients.2
Such programs should be based on guidelines from authoritative sources and should include feedback letters to physicians that are sent within a month of the patient event, says Braslow.
Reminders and physician education should be targeted toward areas where they can have the greatest impact, he says. "You have to pick where you’re going to focus your energy," he says. "With any given group of providers, you probably can’t do more than three interventions at one time without losing them."
United also acknowledges that there may be extenuating circumstances that cause a physician to choose not to follow a clinical guideline with a particular patient. Ultimately, the decision is always left with the physician, and United does not take a punitive or critical approach every time the guideline is not followed, Braslow says.
References
1. Soumerai SB, et al. Adverse outcomes of underuse of beta blockers in elderly survivors of acute myocardial infarction. JAMA 1997; 217:115-121.
2. Brand DA, et al. Cardiologists’ practices compared with practice guidelines: Use of beta-blockers after acute myocardial infarction. J Amer Coll Cardiol 1995; 26:1,432-1,436.
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