Measuring Clinical Effectiveness: DISCUSSION
The CEI is a sophisticated integrated analysis of data from commonly available sources that addresses this question: Did the use of a new medication (e.g., LMWH) increase or decrease the overall cost of caring for inpatients who received it compared with similar patients who received an older medication (e.g., UFH)?
The CEI answers the question by using a hospital’s own data, which is critical in establishing credibility among physicians, pharmacists, and hospital administrators. It provides a natural forum for discussion among these personnel and nonclinical managers because it reflects the economic results of all factors contributing to the final cost of care, including clinical decisions made by physicians and the impact of care processes designed and supported by a hospital. Data aggregation by CEI-DRG and by patient category makes the information more useful to physicians and helps to identify internal benchmarks and segments of clinical care that need scrutiny and improvement. The breakdown by department helps to illuminate examples of highly efficient care as well as opportunities to improve efficiency in care processes.
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The information derived from the CEI allows physicians and other health care providers to approach the hazardous task of modifying practice patterns to balance the financial implications for hospitals with their ethical obligations to their patients. When it is evident that one drug is superior to the other, physicians must recommend the superior drug. In many situations, however, two drugs may be clinically equivalent, or the evidence is not definitive. Armed with information from the CEI, physicians can make an informed decision that will allow them to preserve scarce hospital resources for other patients and the community while honoring their obligation to do the right thing for their patients.
The CEI is currently concerned only with inpatient costs rather than the total cost associated with an episode of care. Although some might consider this evaluation to be incomplete, the fact is that hospitals are paid for the services provided during an inpatient stay and, therefore, must make decisions based on the cost of care during the stay. However, the CEI process in general can be expanded beyond the in-patient setting as needed.
Several enhancements are under development for future versions of the CEI. First, although most of the important clinical differences among patients have been taken into account by adjusting for case mix using a specially designed set of DRG definitions, the CEI-DRGs, some variability in clinical severity remains within the CEI-DRGs. The CEI development team plans to add other risk adjustments to the process soon. canadian antibiotics
Second, detailed charge data will be added for the departments (other than pharmacy) for all participating hospitals. This will allow the accurate tracking of patients receiving non-drug treatments, such as mechanical prophylaxis for DVT. Previously, patients not receiving pharmacological prophylaxis were counted as not having any prophylaxis, because charges for mechanical compression devices did not appear in the pharmacy charge data. Some of the first hospitals to participate in the CEI provided detailed charge data for all departments, thereby allowing for such additional analysis. In the future, this level of detail will be required for all hospitals participating in the CEI.
CONCLUSION
An increasing need among institutional managers and P&T committee members relates to balancing both cost and patient outcome information to reach a health care value point for their organizations. To address that need, the CEI-integrated methodology uses commonly available patient data to expand comparisons of different drugs beyond the pharmacy to encompass all hospital services. This should be seen as a shift in paradigm from the “silo” view of DURs to a broader, total patient-care view. As a result, these key institutional stakeholders can achieve improved decision-making abilities. More important, such information empowers managers and P&T committee decision-makers to determine where to make changes in patient care that will benefit all stakeholders in health care. buy antibiotics amoxicillin
