Project Background
Various researchers, most notably Wennberg and Fisher, have shown that Medicare utilization varies dramatically across the nation, even for substantially similar patients and situations (www.dartmouthatlas.org). Furthermore, high utilization areas are often areas with worse patient outcomes; and higher expenditures do not correlate with higher patient satisfaction. It is therefore possible to improve patient outcomes and satisfaction while reducing expenditures by learning how to constrain utilization that is not justified through yielding substantial benefit.
Costs of medical care are closely related to the number of medical services provided; number of medical services provided is closely related to the capacity to supply those services. Physicians influence both demand and supply of medical services, and are trained to deliver healthcare services in accordance with the perceived best interests of individuals. It is likely that geographic variation in healthcare utilization results from a complex and interdependent relationship of local resource availability, physician culture, patient expectations and other local influences. Many if not all of these parameters may need to be addressed to fully resolve variable utilization patterns.
Project Purpose
The goal of this project is to begin interventions in efficiency by connecting population evidence of utilization patterns and outcomes to decisions made prospectively by individual physicians on behalf of individual patients, and to reduce inefficient resource use and enhance quality through collaboration of physicians and communities with varying patterns. Participant QIOs will:
- Develop a dataset to feed back to providers containing quality metrics, utilization metrics and patient identifiers. The dataset will be comprised of elements currently available to the QIO community.
- Facilitate peer-to-peer interaction between high and low utilizing providers using feedback of the quality and utilization dataset.
- Test interventions to reduce resource use and enhance quality using rapid cycle improvement methods.
Project Products
Products to be derived from this work include:
- Programming code for development of a quality and resource use utilization dataset.
- Identification of resource use metrics useful to providers to inform improvement.
- Resources to assist the greater QIO community in replicating this pilot work.
- Identification and engagement of experts to assist the greater QIO community in replicating this pilot work.
- Compilation of insights and experiences from tests of interventions to inform best practices for assisting providers in moving towards cost and quality transparency.
