Healthcare (Amsterdam, Netherlands)
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Anesthesiologists, as experts in perioperative, critical care and pain management can demonstrate value by being part of teams focusing on outcomes shared by hospitals, surgeons and themselves. This perspective outlines ways in which anesthesiologists can provide leadership in preoperative care, determining the site of surgical care associated with the best outcomes at the lowest cost and treating both in-hospital and chronic care. Providing value for our patients will be our ability to coordinate and to collaborate with other medical professionals throughout the entire care continuum with the goal of improving patient outcome.
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Determining '"value'" in health care, defined as outcomes per unit cost, depends on accurately measuring cost. We used time-driven activity-based costing (TDABC) to determine the cost of care in men with benign prostatic hyperplasia (BPH) - a common urologic condition. ⋯ As financial risk is shifted toward providers, understanding the cost of care will be vital. Future work is needed to determine outcome discrepancy between the diagnostic and surgical modalities in BPH.
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Emerging digital technologies offer enormous potential to improve quality, reduce cost, and increase patient-centeredness in healthcare. Academic Medical Centers (AMCs) play a key role in advancing medical care through cutting-edge medical research, yet traditional models for invention, validation and commercialization at AMCs have been designed around biomedical initiatives, and are less well suited for new digital health technologies. ⋯ These centers show great promise but are also subject to significant financial, organizational, and visionary challenges. We explore these AMC initiatives, which share the following characteristics: a focus on academic research methodology; integration of digital technology in educational programming; evolving models to support "clinician innovators"; strategic academic-industry collaboration and emergence of novel revenue models.
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In addition to supporting the adoption and use of health IT, HITECH also included funds to support independent national program evaluation activities. The main challenges of evaluating health IT programs of the breadth and scale of the HITECH programs are the importance of context in the implementation and impact of the programs, the complexity and heterogeneity of the interventions, and the unpredictable nature of the innovative practices spurred by HITECH. The lessons learned include the importance of tailoring evaluation activities to each phase of implementation, flexible mixed methods, and continuous formative evaluation.
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Although accountable care organizations (ACOs) are rapidly being deployed in Medicare, little is known about how the model might affect high-risk, high cost groups such as cancer patients. The Physician Group Practice Demonstration, which ran from 2005 to 2010 in 10 physician groups, provides the best current evidence on the likely effectiveness of accountable care organizations for Medicare beneficiaries. Changes in cancer treatment and spending under this program may be indicative of cancer treatment under ACO payment reform. ⋯ Inpatient care for beneficiaries with cancer may represent a significant source of potential savings for ACOs, but evidence from the Physician Group Practice Demonstration indicates that no changes were made to cancer treatments such as chemotherapy or surgical procedures.