Article of Interest
April 16, 2014
ARTICLE
DETAIL:
Ask if new technology will make a
difference in patient outcomes
Earlier this year, I completed a medical rotation
in Africa. It was an amazing, eye-opening experience. While I expected it might
be difficult to acquire newer, more expensive medications and procedures, I had
anticipated that, given limited resources, there would be some rationale in
deciding which medications and procedures would be available. I was deeply
mistaken in this assumption.
During my time abroad, I watched several patients
with heart attacks pass away because there was no thrombolytic (clot-busting)
therapy. Thrombolytic medications are inexpensive and have been around for more
than 50 years. The low cost of these medications combined with the high rates
of coronary heart disease makes it puzzling that the hospital did not have
thrombolytic medications.
Instead, the hospital was building a cardiac
catheterization lab. While catheterization can produce better patient outcomes
than thrombolytic therapy for heart attacks, it is significantly more expensive
and good outcomes require skilled interventionists with experience performing a
high volume of catheterizations. In a country with few trained cardiologists
(not to mention interventional cardiologists), this latter resource is
essentially unobtainable.
This was just one example of many puzzling
choices that I saw during my time abroad. Others include the presence of CT and
MRI machines as well as ventilators but an inability to acquire basic labs
including serum bicarbonate levels, arterial blood gas levels or reliable
culture results. To me, it seems that, in a country with high rates of
communicable diseases, reliable culture results are more important for patient
outcomes than an MRI.
While the leaders of the institution had chosen
to invest in the most modern technologies instead of finding the greatest value
for their funds, I want to make clear that this decision is not unique to
those in developing countries. In fact, we in the United States do this all the
time as well.
We often fail to ask if the new, fancy technology
will make the biggest difference in patient outcomes. Has increasing the use
electronic medical records improved care coordination or quality of care? Is a
10 Tesla MRI machine meaningfully different from a 3 or 5 Tesla machine?
Sometimes it is the simple, low-cost changes that
make the greatest difference in patient outcomes. Antimicrobial foam outside
every patient room. Rotating ICU patients every two hours. Removing unnecessary
central lines.
We are a rich country, but we do not have
unlimited resources. We also need to seek the greatest value for our money. We
need high-value health care.
The idea of high-value health care has been
around for several years but has gained increasing traction as our country
begins to recognize that even we have finite resources. The New
England Journal of Medicine and Harvard Business Review recently
collaborated to create an online forum to help health care leaders identify ways to
increase the value of health care.
The Institute for Healthcare Improvement has long
been a proponent of value. Its website contains several resources for
identifying ways to achieve high-value health care. Of particular interest is
its 5 Million Lives Campaign that focused on specific actions
that would prevent 5 million incidents of medical harm in hospitals over a
two-year period.
As future health care providers in the current
health care climate, we will be asked not only to practice evidence-based
medicine but also high-value medicine. It is important that we know what
actions provide the most value in ensuring patient safety and improving patient
outcomes. Now is as good a time as any to start learning.
Elaine Khoong is a medical
student. This article originally appeared in The American
Resident Project.
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