Ten clinician-driven strategies for maximising value of Australian health care
Ian ScottPrincess Alexandra Hospital, Ipswich Road, Woolloongabba, Qld 4102, Australia. Email: ian.scott@health.qld.gov.au
Australian Health Review 38(2) 125-133 https://doi.org/10.1071/AH13248
Submitted: 28 December 2013 Accepted: 6 April 2014 Published: 13 May 2014
Journal Compilation © AHHA 2014
Abstract
Objective To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.
Methods Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.
Results Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low- or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.
Conclusions Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.
What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform.
What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap.
What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low- to high-value care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.
Introduction
Health care in Australia is at a crossroads. In 2009, the Australian Hospital and Health Reform Commission (HHRC)1 noted marked variations in care, suboptimal safety and reliability, fragmentation and discontinuity of care, and unsustainable cost increases. Subsequent studies confirm substantial overuse, underuse and misuse of clinical interventions.2,3 In the US, approximately 30% of healthcare expenditure is wasted on activities that add no value to care;4 the corresponding figure for Australia is unknown, but is likely to be significant. Medicare rebate payments bear little relationship to the health benefits of schedule items, private health insurance premiums continue to rise, many patients face increasing out-of-pocket medical expenses and may soon elect to forego essential care,5 and timely access to emergency care and urgent elective surgery in many locales is suboptimal.6 The productivity of the healthcare workforce, despite a >20% increase in numbers and higher salaries over the past 10 years,7 has remained relatively static. Gains in life expectancy and reduction in disability burden since 2000 have flattened out considerably compared with the previous half century.7 This is despite healthcare expenditure in Australia in 2011–12 growing from 8.2% of gross domestic product (GDP) just 10 years ago to 9.3% now, representing a 68% increase in annual spending (priced in 2001 dollars) from A$77.5 billion to A$130 billion.8 The annual growth in expenditure of 6.8% has far exceeded annual growth in GDP of 3.5%. In recent times, state and federal budget deficits have evoked cuts in hospital funding, closure of beds and services, retrenchment of front-line clinical staff and rising numbers of unemployed medical graduates.
Effects of remedial strategies to date
The political window for substantive, bipartisan healthcare reform based on the blueprint offered by the HHRC1 seems to have passed. The limited commitments to changes in federal and state funding relativities for hospitals and primary care, and the creation of new organisational entities of hospital and health services and Medicare Locals, have yet to show discernible impact on routine care. Hospitalisation persists as a commonly used default care option in the absence of more appropriate models of care in alternative settings.9
Strategies for optimising health care have been pursued, including hospital redesign projects, quality and safety standards and improvement programs, financial incentives, e-health initiatives, clinical practice guidelines and performance measurement and reporting. Unfortunately, for virtually all these initiatives, evidence of overall effectiveness and sustainability remains limited.10–14 Others15 argue instead for more resources to augment existing ‘business as usual’ models of care delivery (despite no consistent relationship between their quality and cost16), enhanced professional education and remuneration, and less ‘red tape’ and poor governance from politicians and bureaucrats.
The need for clinicians to lead efforts to maximise the value of healthcare
The author believes current budgetary fixes to healthcare overspend constitute temporary stop-gaps with little long-term impact, whereas organisational restructuring mostly tinkers at the edges and fails to achieve transformational change. What is required is a fundamental shift of medical practice to maximising high-value care (i.e. care conferring patient-important clinical benefit at lowest per unit cost).17 This requires clinicians from all disciplines to show leadership and critically appraise the value of current practice and take concerted action, in partnership with healthcare managers, towards minimising inappropriate and costly (i.e. low-value) care and maximising highly appropriate, less expensive (i.e. high-value) care.18
Methods
Based on personal experience in specialist clinical practice, evidence-based medicine and quality improvement, strategies were developed by the author that, in combination, could maximise high-value care and render health care more affordable and sustainable. Relevant literature was reviewed in retrieving studies supporting each strategy.
Results and discussion
Ten strategies were developed, as detailed below and summarised in Box 1.
| Box 1. Summary of strategies for clinician-driven healthcare reform |
| 1. Minimise errors in diagnosis |
|
| 2. Discontinue low- or no-value practices that provide little benefit or cause harm |
|
| 3. Defer use of unproven interventions |
|
| 4. Select care options according to comparative cost-effectiveness |
|
| 5. Target clinical interventions to those who derive greatest benefit |
|
| 6. Adopt a more conservative approach nearing the end of life |
|
| 7. Actively involve patients in shared decision-making and self-management |
|
| 8. Minimise day-to-day operational waste |
|
| 9. Convert health care institutions into rapidly learning organisations |
|
| 10. Advocate for integrated systems of care that maximise value |
|
Minimise errors in diagnosis
Cases of delayed, missed and incorrect diagnosis occur with an incidence of between 10% and 20% of clinical encounters.19 Such misdiagnosis results in unnecessary and costly care, with additional litigation costs incurred when serious adverse outcomes ensue. Most errors result from primary defects in clinical reasoning, particularly with regard to undifferentiated clinical presentations. Only in approximately 25% of cases do ‘system’ errors (related to test ordering and result reporting) predominate over reasoning errors, despite much attention being given to the former.19 Greater awareness and acknowledgement of reasoning errors and more training in cognitive and behavioural techniques for minimising reasoning error20 are needed in the curricula of medical schools and speciality colleges.
Overdiagnosis, that is diagnosing ‘diseases’ that do not materially impact on patient longevity or quality of life, is also becoming increasingly prevalent, with rates as high as 30% for breast cancer screening. This has resulted from the greater use of increasingly sensitive diagnostic and screening tests, more liberal disease definitions and more testing in patients with low to very low pretest probability of disease.21 Such overdiagnosis leads to wasteful and potentially harmful overtreatment. Clinicians must acquire a better appreciation of the natural (untreated) history of this expanded spectrum of disease, the risks and consequences of ‘false-positive’ tests and the benefits and harms of active intervention on early stage or self-limiting disease affecting patients with an otherwise good prognosis.21
Discontinue low- or no-value practices that provide little benefit or cause harm
Long-standing clinical practices must be disowned if new evidence reveals they now constitute waste. Between 30% and 50% of contemporary trials that test established practices show that the practices confer little or no benefit, in contradiction to prevailing assumptions.22 Examples include percutaneous coronary artery intervention in stable, non-critical coronary artery disease,23 facility-based cardiac rehabilitation programs following myocardial infarction,24 vertebroplasty for acute osteoporotic fracture25 and blood glucose self-monitoring in stable type 2 diabetes.26 Such discredited practices tend to persist, often for years,27 sustained sometimes by vested commercial interests, but more often by strongly held professional beliefs.28 Requests for investigations such as vitamin B12, folate29 and vitamin D30 assays, and computed tomography (CT) scans for back pain and chest diseases31 have surged in recent years despite considerable doubt as to their usefulness to decision making. In response, more than 50 speciality colleges in the US, as part of a national Choosing Wisely campaign, have identified more than 250 low- or no-value interventions relating to common clinical scenarios,32 which they recommend their colleagues desist in providing. In Australia, researchers have identified more than 150 high-volume Medicare Benefits Schedule (MBS) items of potentially low value.33 Speciality colleges in this country would do well to emulate the US campaign and engage their constituencies in identifying and discouraging ineffective care.
Defer the use of unproven interventions
Widespread use of new interventions should be avoided in circumstances where their effectiveness and safety remain uncertain. Examples of premature adoption of new technologies include endovascular intervention in acute stroke,34 use of CT coronary angiography35 and high-sensitivity cardiac troponin assays36 in assessment of acute chest pain and renal denervation in treatment-resistant hypertension.37 Another problem is ‘indication creep’, whereby proof-of-benefit in selected patient groups is extrapolated uncritically to a wider spectrum of patients. Overseas studies suggest many implantations of costly devices, such as cardioverter–defibrillators,38 resynchronisation pacemakers39 and transcatheter aortic valves,40 involve unproven indications. Both scenarios can lead to harm being done to some patients and resources being wasted. Expert opinion leaders and clinical guideline panels must provide accurate and unbiased evidence reviews of new technologies and only recommend their use in routine practice in situations where their benefits and harms in specific patient populations have been definitively elucidated on the basis of robust evidence from clinical trials and registries.
Select care options according to comparative cost-effectiveness
Many care standards entail high-intensity management regimens as opposed to less intense and expensive regimens that can be just as safe and effective.41 Examples of ‘less is more’ include low-dose intravenous bolus injections of proton pump inhibitors versus continuous high-dose infusions in bleeding peptic ulcers,42 short (5 days) versus standard (≥10 days) duration oral steroids in acute exacerbations of chronic obstructive pulmonary disease,43 short (2–4 days) versus standard (7–14 days) duration antibiotics in paediatric urinary tract infections44 and clinically indicated versus routine (every 72 h) replacement of intravenous cannulas.45
Where different interventions are available for the same disease, the less cost-effective options are often chosen under the influence of commercial interests or regulatory requirements. Historical examples include a preference for expensive renin–angiotensin–aldosterone system antagonists and calcium channel blockers over cheaper thiazide diuretics as first-line agents in the treatment of essential hypertension,46 for naltrexone or acamprosate over supervised disulfuram in the treatment of alcohol dependence,47 heparin and glycoprotein inhibitors over bivalirudin or fondapurinex in percutaneous coronary intervention48,49 and time-consuming risk assessment tools over experienced nurse judgements in evaluating pressure ulcer risk.50
The American College of Physicians in the US51 and the British Thoracic Society in the UK52 are educating their members in the principles of comparative cost-effectiveness and leading demonstration projects aimed at maximising the cost-effective use of technologies. Australian colleges should do likewise in fostering greater adoption of a ‘less is more’ reappraisal of existing practice and developing lists of alternative, more cost-effective interventions applicable to commonly encountered clinical scenarios.
Target clinical interventions to those who derive greatest benefit
Patients at highest absolute risk of adverse events due to common diseases, such as acute coronary syndromes (ACS) and non-valvular atrial fibrillation (NVAF), often receive the lowest treatment intensity, even after accounting for treatment-specific contraindications.53,54 Maximising treatment benefit while minimising treatment harm requires better targeting of interventions to individual patients by using risk prediction rules that accurately quantify benefit–harm trade-offs. For example, in the case of patients with NVAF, using the CHADS2 (congestive heart failure, hypertension, age >75, diabetes mellitus, and prior stroke or transient ischaemic attack (doubled)) score55 (risk of stroke if not treated) and the HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile INR (international normalised ratio), elderly, drugs/alcohol concomitantly) score56 (risk of bleeding if treated with anticoagulants) directs treatment to those who are likely to attract the maximum net gain. With regard to primary cardiovascular disease (CVD) prevention, expensive statins are prescribed to many people at low absolute risk (<10% CVD event rate over 10 years) on the basis of isolated elevations in serum lipids,57 whereas more clinical benefit would be gained for the same outlays if such treatment was directed preferentially at those at high risk (>20% event rate over 10 years),58 including those with established CVD. Achieving optimal risk factor modification and drug use in all patients with recent ACS would reduce hospital readmissions for recurrent ACS-related complications within 1 year by almost half.59
Adopt a more conservative approach nearing the end of life
Approximately 30% of healthcare budgets are spent on patient care in the last year of life, with acute care in the final month accounting for one-third of this expenditure.60 Almost two-thirds of terminally ill people for whom home or hospice palliative care would be appropriate die in hospital,61 often receiving heroic interventions. In one study, 25% of beds in 69 intensive care units (ICUs) were occupied by patients whom attending intensivists perceived as receiving inappropriate care.62
A more conservative or palliative approach to end-of-life care has been shown, in the case of patients with advanced cancer, to prolong survival, improve symptoms, avoid invasive care, reduce hospital stays and lower costs (by up to one-third63) compared with more aggressive care.64 Similar outcomes are possible if advance care planning was systematically applied to patients with end-stage chronic diseases.65 In one study, such an approach reduced both days and costs of hospitalisation in the last year of life by almost one-third.66 Inappropriate overinvestigation and over-treatment of older patients with multimorbidity can be minimised by management approaches that integrate care-specific benefit–harm trade-offs with life expectancy, care goals and patients’ values and preferences.67
Actively involve patients in shared decision making and self-management
Empowering patients to actively participate in decision making and self-management appears to reduce demand for some forms of care.68 As many as 20% of patients who actively participate in discussions using decision aids choose less invasive and costly interventions than those who do not.69 In one study, providing decision aids to patients potentially eligible for hip and knee replacements reduced surgeries by up to 38% and costs by up to 21% over 6 months.70 In another study, shared decision making across a range of conditions facilitated by regular contact with trained health coaches resulted in 13% fewer hospital admissions, 10% reduction in preference-sensitive surgeries and 5% lower overall medical costs compared with usual care.71 Patients with chronic diseases, such as diabetes, heart failure and asthma, and who are poorly ‘activated’ (i.e. lacking skills and confidence in managing their own diseases) demonstrate worse outcomes at higher cost72 (up to 12% higher per capita cost73) than those who are highly activated, after adjusting for demographic characteristics and illness severity. Interventions such as coaching tailored to a patient’s level of activation can increase activation levels, improve health indicators and reduce costs.74,75 At the population level, whole communities, comprising both current and future patients, could be engaged by way of citizen juries in discussions around what constitutes value-added, preference-sensitive care choices for common clinical scenarios.76
Minimise day-to-day operational waste
Considerable aggregate waste exists in everyday healthcare operations in a variety of forms, including: (1) unnecessary investigations, such as duplicating tests already performed in other laboratories, retesting within short time intervals, requesting overinclusive test batteries and needless preoperative tests; (2) misused treatments, such as continuing treatments when the original indication has lapsed or incorrect drug administration (wrong dose, duration or route of administration); (3) avoidable defects in care delivery, such as health care-associated infections, late cancellations of elective surgery and preventable adverse drug events; (4) wasteful inventories, such as using expensive patented medicines rather than cheaper generic brands,77 using costly devices and prostheses rather than less costly alternatives and using disposable equipment and apparel rather than reusable items; and (5) inefficient work practices, whereby highly-skilled, highly-paid clinicians perform low-order, administrative and other non-clinical tasks that could be abandoned, automated or delegated to lower-paid workers.78 Much of this waste not only incurs costs due to delays in care or redoing previous work, but also results in patient harm and dissatisfaction.
The Institute of Healthcare Improvement in the US has produced a ‘waste reduction tool’ that provides a snapshot of potential areas of waste within a hospital, as identified by frontline clinical staff.79 Using this snapshot, representatives of the clinician community, finance department and hospital executive engage in detailed analysis of the findings to prioritise and implement waste reduction initiatives. Several US hospitals have reported more efficient use of nursing hours and bed days, fewer complications and readmissions, lower costs and improved clinical outcomes across a range of clinical services.80,81 A recent report from the Grattan Institute estimated A$928 million of avoidable costs within Australian public hospitals each year as a result of unusually high length of stay, supply prices, numbers of tests and treatments per patient, staffing ratios and overhead costs.82 Another report from the same institute estimated savings of $420 million per year resulting from greater substitution of lower-order tasks by nursing and allied health assistants and specialist nurses in anaesthesia and endoscopy.83 At a local level, in the author’s institution, a program of drug use optimisation resulted in savings of A$1.18 million over 8 months.
Clinicians must collaborate with managers in negotiating supply contracts, drug formularies and device and prosthesis inventories; developing and auditing care protocols; standardising and, where possible, automating ‘low-order’ clinical and non-clinical tasks; reconfiguring job descriptions and remuneration arrangements (where appropriate) to better align value and cost; and implementing quality and safety improvement programs of proven value.84
Convert health care institutions into rapidly learning organisations
Conventional research based on formal, highly protocolised controlled trials is often too slow and expensive in solving many care delivery problems.85 More can be gained from cultivating clinician-innovators, acting either independently or as part of multisite collaborations, who develop, implement, re-evaluate and readjust changes in clinical practice in response to deficiencies they themselves have discerned within existing practice based on reliable measurements and feedback. This clinician-led ‘in the field’ action research allows work flow and clinician acceptability to be built into the iterative process while minimising time or money foregone in the event of failure. Such an approach underpinned highly successful programs for preventing catheter-related bloodstream infections in ICUs86 and reducing operating theatre mishaps,87 with resultant cost savings.
In accelerating this creation and diffusion of value-adding innovation, healthcare institutions, whether they be hospitals or general practitioner clinics, must become rapid learning organisations that constantly measure and compare costs and outcomes of care with those of their peers, make changes to improve and re-evaluate.88 Costs and outcomes must be measured longitudinally over the full cycle of care for a medical condition, not separately for each intervention, and outcomes include not only survival, but also the degree and sustainability of health or recovery achieved, the time taken for recovery and any care-related harms.89 Rapidly learning organisations both evolve improved care internally and proactively look for, and import (with local adaptation), innovations from others. They feature clinical information systems and business intelligence units that collect, analyse and report cost and clinical data in real time. They seek out and collaborate with other like-minded organisations and try to integrate patient-centred care across all sectors of healthcare. Organisations such as these have been shown to deliver high-value care at lower costs.90,91
Advocate for integrated systems of care that maximise value
The way the healthcare system is currently organised is inefficient in meeting the present and future care needs of the population, especially the chronically ill with multimorbidities.6 ‘Siloed’ clinical care and increasing super-specialisation has diminished accessibility and coordination of care for such patients, allowed unnecessary duplication of services and suboptimal health outcomes, and retarded the adoption of more effective, generalist-based models of care.4 Patients want their clinicians to take a holistic, rather than a disease-based, approach to their care and coordinate and communicate it across care settings.92 The current system of uncoordinated, sequential visits to multiple clinicians, departments and specialties works against value. Instead, integrated, team-based practice units are needed that encompass all essential skills and services required over the full cycle of care for common medical conditions and their related comorbidities. Such units should include outpatient and inpatient care, testing, education and coaching, rehabilitation, end-of-life care and home support services within the same actual or virtual organisation. More emphasis needs to be given to delivering high-value prevention, wellness, screening and health maintenance services at the primary care level, integrated with relevant specialist providers.93
Examples of such integrated practice include area-wide hospital substitution programs,94 hospital-wide patient flow programs,95 reconfigured emergency–acute care systems based on patient complexity and urgency,96,97 collaborative primary care specialist teams based in non-hospital settings caring for patients with chronic diseases,98,99 primary care substitution of specialist services100 and multidisciplinary, patient-centred medical homes.101
Conclusion
The challenge to clinicians of maximising value of care should not be underestimated, given entrenched beliefs and potentially legitimate concerns of some that established practices regarded as beneficial could be subject to premature disinvestment in response to new utilisation metrics (linked to pay-for-performance and quality assurance programs) that have not been properly validated. Nevertheless, only clinicians and their professional organisations can enact the above set of interdependent strategies for improving value, because ultimately value is determined by how medicine is practiced. Although system-level remedies for cost containment proposed by organisational analysts are not without merit,102 clinicians must lead efforts to maximise high-value care. If they fail to do so, then looming insolvency of the healthcare system amidst grid-locked professional self-interest and conservatism may cause governments to consider severe cost-cutting measures, rationing of services, cumbersome remuneration formulas and major limits to professional autonomy that could inflict serious harm on the populations they serve.
Competing interests
None declared.
Acknowledgement
The author is a chief investigator in the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Quality and Safety in Integrated Primary/Secondary Care, which sponsored this work (NHMRC grant no. 1001157).
References
[1] National Health and Hospitals Reform Commission. A healthier future for all Australians. Final report. Canberra: Australia Government; 2009.[2] Segard T, Macdonald WBG. Changing trends in venous thromboembolism-related imaging in Western Australian teaching hospitals, 2002–2012. Med J Aust 2013; 198 100–3.
| Changing trends in venous thromboembolism-related imaging in Western Australian teaching hospitals, 2002–2012.Crossref | GoogleScholarGoogle Scholar | 23373501PubMed |
[3] Runciman WB, Hunt TD, Hannaford NA, Hibbert PD, Westbrook JI, Coiera EW, Day RO, Hindmarsh DM, McGlynn EA, Braithwaite J. CareTrack: assessing the appropriateness of health care delivery in Australia. Med J Aust 2012; 197 100–5.
| CareTrack: assessing the appropriateness of health care delivery in Australia.Crossref | GoogleScholarGoogle Scholar | 22794056PubMed |
[4] Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA 2012; 307 1513–16.
| Eliminating waste in US health care.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XlvVWhs7k%3D&md5=4891d4c22585855d916997a0312a178dCAS | 22419800PubMed |
[5] Yusuf F, Leeder SR. Can’t escape it: the out-of-pocket cost of health care in Australia. Med J Aust 2013; 199 475–8.
| Can’t escape it: the out-of-pocket cost of health care in Australia.Crossref | GoogleScholarGoogle Scholar | 24099208PubMed |
[6] Australian Institute of Health and Welfare (AIHW). Australian hospital statistics 2011–12. Health services series no. 50. Catalogue no. HSE 134. Canberra: AIHW; 2013.
[7] Australian Institute of Health and Welfare (AIHW). Australia’s health 2012. Australia’s health series no. 13. Catalogue no. AUS 156. Canberra: AIHW. 2012.
[8] Australian Institute of Health and Welfare (AIHW). Health expenditure Australia 2010–11. Health and welfare expenditure series no. 47. Catalogue no. HWE 56. Canberra: AIHW; 2012.
[9] Scott IA. Public hospital bed crisis in Australia: too few or too misused? Aust Health Rev 2010; 34 317–24.
| Public hospital bed crisis in Australia: too few or too misused?Crossref | GoogleScholarGoogle Scholar | 20797364PubMed |
[10] DelliFraine JL, Langabeer JR, Nembhard IM. Assessing the evidence of Six Sigma and Lean in the health care industry. Qual Manag Health Care 2010; 19 211–25.
| Assessing the evidence of Six Sigma and Lean in the health care industry.Crossref | GoogleScholarGoogle Scholar | 20588140PubMed |
[11] Leistikow IP, Kalkman CJ, de Bruijn H. Why patient safety is such a tough nut to crack. BMJ 2011; 342 d3447
| Why patient safety is such a tough nut to crack.Crossref | GoogleScholarGoogle Scholar | 21693533PubMed |
[12] Glasziou PP, Buchan H, Del Mar C, Doust J, Harris M, Knight R, Scott A, Scott IA, Stockwell A. When financial incentives do more good than harm: a checklist. BMJ 2012; 345 e5047
| When financial incentives do more good than harm: a checklist.Crossref | GoogleScholarGoogle Scholar | 22893568PubMed |
[13] Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The impact of eHealth on the quality and safety of health care: a systematic review. PLoS Med 2011; 8 e1000387
| The impact of eHealth on the quality and safety of health care: a systematic review.Crossref | GoogleScholarGoogle Scholar | 21267058PubMed |
[14] Fung CH, Lim Y-W, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med 2008; 148 111–23.
| Systematic review: the evidence that publishing patient care performance data improves quality of care.Crossref | GoogleScholarGoogle Scholar | 18195336PubMed |
[15] Australian Medical Association. Public hospital report card 2013. An AMA analysis of Australia’s public hospital system. Available at https://ama.com.au/ama-public-hospital-report-card-2013 [verified 7 March 2013].
[16] Hussey PS, Wertheimer S, Mehrotra A. The association between health care quality and cost. Ann Intern Med 2013; 158 27–34.
| The association between health care quality and cost.Crossref | GoogleScholarGoogle Scholar | 23277898PubMed |
[17] Porter M, Lee TH. The strategy that will fix health care. Harv Bus Rev 2013; 91 50–68.
[18] Brook RH. The role of physicians in controlling medical care costs and reducing waste. JAMA 2011; 306 650–1.
| The role of physicians in controlling medical care costs and reducing waste.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXhtVWlsrrF&md5=43e90538e29d676ceae8a762a7991f28CAS | 21828329PubMed |
[19] Berner ES, Graber ML. Overconfidence as a cause of diagnostic error in medicine. Am J Med 2008; 121 S2–23.
| Overconfidence as a cause of diagnostic error in medicine.Crossref | GoogleScholarGoogle Scholar | 18440350PubMed |
[20] Scott IA. Errors in clinical reasoning: causes and remedial strategies. BMJ 2009; 338 b1860
| 19505957PubMed |
[21] Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ 2012; 344 e3502
| Preventing overdiagnosis: how to stop harming the healthy.Crossref | GoogleScholarGoogle Scholar | 22645185PubMed |
[22] Prasad V, Gall V, Cifu A. The frequency of medical reversal. Arch Intern Med 2011; 171 1675–6.
| The frequency of medical reversal.Crossref | GoogleScholarGoogle Scholar | 21747003PubMed |
[23] Stergiopoulos K, Brown DL. Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials. Arch Intern Med 2012; 172 312–19.
| Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials.Crossref | GoogleScholarGoogle Scholar | 22371919PubMed |
[24] West RR, Jones DA, Henderson AH. Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction. Heart 2012; 98 637–44.
| Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction.Crossref | GoogleScholarGoogle Scholar | 22194152PubMed |
[25] Staples MP, Kallmes DF, Comstock BA, Jarvik JG, Osborne RH, Heagerty PJ, Buchbinder R. Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis. BMJ 2011; 343 d3952
| Effectiveness of vertebroplasty using individual patient data from two randomised placebo controlled trials: meta-analysis.Crossref | GoogleScholarGoogle Scholar | 21750078PubMed |
[26] Farmer AJ, Perera R, Ward A, Heneghan C, Oke J, Barnett AH, Davidson MB, Guerci B, Coates V, Schwedes U, O’Malley S. Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. BMJ 2012; 344 e486
| Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes.Crossref | GoogleScholarGoogle Scholar | 22371867PubMed |
[27] Tatsioni A, Bonitsis NG, Ioannidis JPA. Persistence of contradicted claims in the literature. JAMA 2007; 298 2517–26.
| Persistence of contradicted claims in the literature.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXhsVSlu7fE&md5=b352b5191ae082581f109281f515709eCAS | 18056905PubMed |
[28] Scott IA, Elshaug A. Foregoing low value care: how much evidence is needed to change beliefs? Intern Med J 2013; 43 107–9.
| Foregoing low value care: how much evidence is needed to change beliefs?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3szns1GmtA%3D%3D&md5=a8d6e1c9d55d2c409cb39bbea1293428CAS | 23402482PubMed |
[29] Willis CD, Metz MP, Hiller JE, Elshaug AG. Vitamin B12 and folate tests: the ongoing need to determine appropriate use and public funding. Med J Aust 2013; 198 586–8.
| Vitamin B12 and folate tests: the ongoing need to determine appropriate use and public funding.Crossref | GoogleScholarGoogle Scholar | 23919693PubMed |
[30] Bilinski KL, Boyages SC. The rising cost of vitamin D testing in Australia: time to establish guidelines for testing. Med J Aust 2012; 197 90
| The rising cost of vitamin D testing in Australia: time to establish guidelines for testing.Crossref | GoogleScholarGoogle Scholar | 22794049PubMed |
[31] Mendelson RM, Murray CP. Towards the appropriate use of diagnostic imaging. Med J Aust 2007; 187 5–6.
| 17605694PubMed |
[32] Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA 2012; 307 1801–2.
| 1:CAS:528:DC%2BC38Xms1ajtLk%3D&md5=aa012e46ae1e60b0c2f400356931b98aCAS | 22492759PubMed |
[33] Elshaug AG, Watt AM, Mundy L. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197 556–60.
| Over 150 potentially low-value health care practices: an Australian study.Crossref | GoogleScholarGoogle Scholar | 23163685PubMed |
[34] Chimowitz MI. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368 952–5.
| Endovascular treatment for acute ischemic stroke.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXjvFChs74%3D&md5=b503883d74729944f5b8ad3a75df22dfCAS | 23394477PubMed |
[35] Scott IA. Using computerised tomography coronary angiography to evaluate patient with acute chest pain: putting the horse before the cart. Intern Med J 2011; 41 647–50.
| Using computerised tomography coronary angiography to evaluate patient with acute chest pain: putting the horse before the cart.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3MfhvF2itw%3D%3D&md5=eda352e20e574917586087792687de0eCAS | 21899679PubMed |
[36] Scott IA, Cullen LA, Tate J, Parsonage W. High-sensitivity troponin assays: a two-edged sword? Med J Aust 2012; 197 320–3.
| High-sensitivity troponin assays: a two-edged sword?Crossref | GoogleScholarGoogle Scholar | 22994813PubMed |
[37] Baker NC, Waksman R. Editorial: renal sympathetic denervation: a true lack of efficacy, or the victim of a ‘perfect storm’? Cardiovasc Revasc Med 2014; 15 61–2.
| 24684755PubMed |
[38] Al-Khatib SM, Hellkamp A, Curtis J, Mark D, Peterson E, Sanders GD, Heidenreich PA, Hernandez AF, Curtis LH, Hammill S. Non-evidence-based ICD implantations in the United States. JAMA 2011; 305 43–9.
| Non-evidence-based ICD implantations in the United States.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXkslWhsw%3D%3D&md5=562959746cdd4fdaedbcaab0b1a2f8e2CAS | 21205965PubMed |
[39] Sipahi I, Carrigan TP, Rowland DY, Stambler BS, Fang JC. Impact of QRS duration on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Arch Intern Med 2011; 171 1454–62.
| Impact of QRS duration on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials.Crossref | GoogleScholarGoogle Scholar | 21670335PubMed |
[40] Van Brabandt H, Neyt M, Hulstaert F. Transcatheter aortic valve implantation (TAVI): risky and costly. BMJ 2012; 345 e4710
| Transcatheter aortic valve implantation (TAVI): risky and costly.Crossref | GoogleScholarGoogle Scholar | 22849955PubMed |
[41] Scott IA. Comparative effectiveness research: the missing link in evidence-informed medicine and healthcare policy-making. Med J Aust 2013; 198 310–2.
| Comparative effectiveness research: the missing link in evidence-informed medicine and healthcare policy-making.Crossref | GoogleScholarGoogle Scholar | 23545024PubMed |
[42] Wang C-H, Ma MH-M, Chou H-C, Yen ZS, Yang CW, Fang CC, Chen SC. High-dose vs non-high-dose proton pump inhibitors after endoscopic treatment in patients with bleeding peptic ulcer. A systematic review and meta-analysis of randomized controlled trials. Arch Intern Med 2010; 170 751–8.
| High-dose vs non-high-dose proton pump inhibitors after endoscopic treatment in patients with bleeding peptic ulcer. A systematic review and meta-analysis of randomized controlled trials.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXntlOntLk%3D&md5=0f64e6b143900e0fa3c5151a72f48ebaCAS | 20458081PubMed |
[43] Leuppi JD, Schuetz P, Bingisser R, Bodmer M, Briel M, Drescher T, Duerring U, Henzen C, Leibbrandt Y, Maier S, Miedinger D, Müller B, Scherr A, Schindler C, Stoeckli R, Viatte S, von Garnier C, Tamm M, Rutishauser J. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013; 309 2223–31.
| Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhtFalsbzJ&md5=9daf1d21439bf2329511b45f36dc2b14CAS | 23695200PubMed |
[44] Michael M, Hodson EM, Craig JC, Martin S, Moyer V. Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomised controlled trials. Arch Dis Child 2002; 87 118–23.
| Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomised controlled trials.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38zovFWmsw%3D%3D&md5=b005306a13693c10f04bd3577b24d9e0CAS | 12138060PubMed |
[45] Webster J, Osborne S, Rickard CM, New K. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2013; 4 CD007798
| 23633346PubMed |
[46] Wright JT, Probstfield JL, Cushman WC, Pressel SL, Cutler JA, Davis BR, Einhorn PT, Rahman M, Whelton PK, Ford CE, Haywood LJ, Margolis KL, Oparil S, Black HR, Alderman MH, ALLHAT Collaborative Research Group ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses. Arch Intern Med 2009; 169 832–42.
| ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1MXmt1SksrY%3D&md5=0c539e7c0410b05c39b5e0086dc890edCAS | 19433694PubMed |
[47] Laaksonen E, Koski-Jännes A, Salaspuro M, Ahtinen H, Alho H. A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol Alcohol 2008; 43 53–61.
| A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXhtFSjsg%3D%3D&md5=568b09483e6efee1adf488ebe9c9053cCAS | 17965444PubMed |
[48] Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006; 354 1464–76.
| Comparison of fondaparinux and enoxaparin in acute coronary syndromes.Crossref | GoogleScholarGoogle Scholar | 16537663PubMed |
[49] Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, White HD, Pocock SJ, Ware JH, Feit F, Colombo A, Aylward PE, Cequier AR, Darius H, Desmet W, Ebrahimi R, Hamon M, Rasmussen LH, Rupprecht HJ, Hoekstra J, Mehran R, Ohman EM, ACUITY Investigators Bivalirudin for patients with acute coronary syndromes. N Engl J Med 2006; 355 2203–16.
| Bivalirudin for patients with acute coronary syndromes.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD28Xht1Chsb3L&md5=97259d1618de0351d0cbcc151e1da0f8CAS | 17124018PubMed |
[50] Webster J, Coleman K, Mudge A, Marquart L, Gardner G, Stankiewicz M, Kirby J, Vellacott C, Horton-Breshears M, McClymont A. Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial). BMJ Qual Saf 2011; 20 297–306.
| Pressure ulcers: effectiveness of risk-assessment tools. A randomised controlled trial (the ULCER trial).Crossref | GoogleScholarGoogle Scholar | 21262791PubMed |
[51] Owens DK, Qaseem A, Chou R, Shekelle P, Clinical Guidelines Committee of the American College of Physicians High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med 2011; 154 174–80.
| High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions.Crossref | GoogleScholarGoogle Scholar | 21282697PubMed |
[52] Williams S, Baxter N, Holmes S, Restrick L, Scullion J, Ward M. IMPRESS guide to the relative value of interventions for people with COPD: a population-based approach to improving outcomes for people with chronic obstructive pulmonary disease based on the cost of delivering those outcomes. British Thoracic Society; 2012. Available at http://www.impressresp.com/index.php?option=com_docman&Itemid=82[verified 12 May 2013].
[53] Scott IA, Derhy P, O’Connor D, Lindsay KA, Atherton JJ, Jones MA. Discordance between level of risk and treatment intensity in patients with acute coronary syndromes. Med J Aust 2007; 187 153–9.
| 17680740PubMed |
[54] Sandhu RK, Bakal JA, Ezekowitz JA, McAlister FA. The risk–treatment paradox in patients with newly diagnosed non-valvular atrial fibrillation. Heart 2011; 97 2046–50.
| The risk–treatment paradox in patients with newly diagnosed non-valvular atrial fibrillation.Crossref | GoogleScholarGoogle Scholar | 22076011PubMed |
[55] National Prescribing Service Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137 263–72.
| 19762550PubMed |
[56] Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 2010; 138 1093–100.
| 20299623PubMed |
[57] Johansen ME, Gold KJ, Sen A, Arato N, Green LA. A national survey of the treatment of hyperlipidaemia in primary prevention. JAMA Intern Med 2013; 173 586–8.
| A national survey of the treatment of hyperlipidaemia in primary prevention.Crossref | GoogleScholarGoogle Scholar | 23478751PubMed |
[58] Eddy DM, Adler J, Patterson B, Lucas D, Smith KA, Morris M. Individualized guidelines: the potential for increasing quality and reducing costs. Ann Intern Med 2011; 154 627–34.
| Individualized guidelines: the potential for increasing quality and reducing costs.Crossref | GoogleScholarGoogle Scholar | 21536939PubMed |
[59] Clark AM, Hartling L, Vandermeer B, McAlister FA. Secondary prevention program for patients with coronary artery disease: a meta-analysis of randomized control trials. Ann Intern Med 2005; 143 659–72.
| Secondary prevention program for patients with coronary artery disease: a meta-analysis of randomized control trials.Crossref | GoogleScholarGoogle Scholar | 16263889PubMed |
[60] Emanuel EJ, Ash A, Yu W, Gazelle G, Levinsky NG, Saynina O, McClellan M, Moskowitz M. Managed care, hospice use, site of death, and medical expenditures in the last year of life. Arch Intern Med 2002; 162 1722–8.
| Managed care, hospice use, site of death, and medical expenditures in the last year of life.Crossref | GoogleScholarGoogle Scholar | 12153375PubMed |
[61] Rosenwax LK, McNamara BA, Murray K, McCabe RJ, Aoun SM, Currow DC. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. Med J Aust 2011; 194 570–3.
| 21644868PubMed |
[62] Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, Michalsen A, Maia PA, Owczuk R, Rubulotta F, Depuydt P, Meert AP, Reyners AK, Aquilina A, Bekaert M, Van den Noortgate NJ, Schrauwen WJ, Benoit DD, APPROPRICUS Study Group of the Ethics Section of the ESICM Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA 2011; 306 2694–703.
| Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XislKjtA%3D%3D&md5=116eaacd402a1c25a8c66b52c4e3c245CAS | 22203538PubMed |
[63] Zhang B, Wright AA, Huskamp HA, Nilsson ME, Maciejewski ML, Earle CC, Block SD, Maciejewski PK, Prigerson HG. Health care costs in the last week of life. Associations with end-of-life conversations. Arch Intern Med 2009; 169 480–8.
| Health care costs in the last week of life. Associations with end-of-life conversations.Crossref | GoogleScholarGoogle Scholar | 19273778PubMed |
[64] Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010; 363 733–42.
| Early palliative care for patients with metastatic non-small-cell lung cancer.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXhtVCrt7nP&md5=7b130ec2f5668244ff6ef94093245396CAS | 20818875PubMed |
[65] Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300 1665–73.
| Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXht1ejsrjI&md5=59c2e5f5e8264f590f38b01b5b180204CAS | 18840840PubMed |
[66] Abel J, Pring A, Rich A, Malik T, Verne J. The impact of advance care planning on place of death, a hospice retrospective cohort study. BMJ Support Palliat Care 2013; 3 168–73.
| The impact of advance care planning on place of death, a hospice retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 23626905PubMed |
[67] Scott IA, Mitchell GK, Reymond EJ, Daly MP. Difficult but necessary conversations: the case for advance care planning. Med J Aust 2013; 199 662–6.
| Difficult but necessary conversations: the case for advance care planning.Crossref | GoogleScholarGoogle Scholar | 24237095PubMed |
[68] Stiggelbout AM, Van der Weijden T, De Wit MP, Frosch D, Légaré F, Montori VM, Trevena L, Elwyn G. Shared decision making: really putting patients at the centre of healthcare. BMJ 2012; 344 e256
| Shared decision making: really putting patients at the centre of healthcare.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC387os1egsw%3D%3D&md5=183aafa00c1c3c992be3e4dd0c43ee1bCAS | 22286508PubMed |
[69] Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2011; 10 CD001431
| 21975733PubMed |
[70] Arterburn D, Wellman R, Westbrook E, Rutter C, Ross T, McCulloch D, Handley M, Jung C. Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Aff (Millwood) 2012; 31 2094–104.
| Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs.Crossref | GoogleScholarGoogle Scholar | 22949460PubMed |
[71] Veroff D, Marr A, Wennberg DE. Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions. Health Aff (Millwood) 2013; 32 285–93.
| Enhanced support for shared decision making reduced costs of care for patients with preference-sensitive conditions.Crossref | GoogleScholarGoogle Scholar | 23381521PubMed |
[72] DeMonaco HJ, von Hippel E. Reducing medical costs and improving quality via self-management tools. PLoS Med 2007; 4 e104
| Reducing medical costs and improving quality via self-management tools.Crossref | GoogleScholarGoogle Scholar | 17439292PubMed |
[73] Hibbard JH, Greene J, Overton V. Patients with lower activation associated with higher costs; delivery systems should know their patients’ ‘scores.’ Health Aff (Millwood) 2013; 32 216–22.
| Patients with lower activation associated with higher costs; delivery systems should know their patients’ ‘scores.’Crossref | GoogleScholarGoogle Scholar | 23381513PubMed |
[74] Hibbard JH, Greene J, Tusler M. Improving the outcomes of disease management by tailoring care to the patient’s level of activation. Am J Manag Care 2009; 15 353–60.
| 19514801PubMed |
[75] Shively MJ, Gardetto NJ, Kodiath MF, Kelly A, Smith TL, Stepnowsky C, Maynard C, Larson CB. Effect of patient activation on self-management in patients with heart failure. J Cardiovasc Nurs 2013; 28 20–34.
| Effect of patient activation on self-management in patients with heart failure.Crossref | GoogleScholarGoogle Scholar | 22343209PubMed |
[76] Mooney GH, Blackwell SH. Whose health service is it anyway? Community values in healthcare. Med J Aust 2004; 180 76–8.
| 14723590PubMed |
[77] Clarke PM, Fitzgerald EM. Expiry of patent protection on statins: effects on pharmaceutical expenditure in Australia. Med J Aust 2010; 192 633–6.
| 20528715PubMed |
[78] Scott IA. Healthcare workforce crisis: too few or too disabled? Med J Aust 2009; 190 689–92.
| 19527205PubMed |
[79] Resar RK, Griffin FA, Kabcenell A, Bones C. Hospital inpatient waste identification tool. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2011. Available at http://www.ihi.org/resources/Pages/IHIWhitePapers/HospitalInpatientWasteIDToolWhitePaper.aspx [verified 20 November 2013].
[80] Martin LA, Neumann CW, Mountford J, Bisognano M, Nolan TW. Increasing efficiency and enhancing value in health care: ways to achieve savings in operating costs per year. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2009. Available at http://www.ihi.org/IHI/Results/WhitePapers/IncreasingEfficiencyEnhancingValueinHealthCareWhitePaper.htm [verified 30 November 2013].
[81] Cosgrove D, Fisher M, Gabow P, Gottlieb G, Halvorson G, James B, Kaplan G, Perlin J, Petzel R, Steele G, Toussaint J. A CEO checklist for high-value health care. Washington, DC: Institute of Medicine; 2012. Available at http://www.iom.edu/~/media/Files/Perspectives-Files/2012/Discussion-Papers/CEOHighValueChecklist.pdf [verified 20 November 2013].
[82] Duckett SJ, Breadon P, Weidmann B, Nicola I. Controlling costly care: a billion dollar hospital opportunity. Melbourne: Grattan Institute; 2014.
[83] Duckett S, Breadon P, Farmer J. Unlocking skills in hospitals: better jobs, more care. Melbourne: Grattan Institute; 2014.
[84] Scott IA, Wakefield J. Deciding when quality and safety improvement interventions warrant widespread adoption. Med J Aust 2013; 198 408–10.
| Deciding when quality and safety improvement interventions warrant widespread adoption.Crossref | GoogleScholarGoogle Scholar | 23641982PubMed |
[85] Zuckerman B, Margolis PA, Mate KS. Health services innovation. The time is now. JAMA 2013; 309 1113–14.
| Health services innovation. The time is now.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXltlOrurg%3D&md5=b18d5011bd37731ec66ce462de41ad26CAS | 23512055PubMed |
[86] Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355 2725–32.
| An intervention to decrease catheter-related bloodstream infections in the ICU.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXhslSmtA%3D%3D&md5=4193923adebde8d629f68989a0ce52e2CAS | 17192537PubMed |
[87] Borchard A, Schwappach DL, Barbir A, Bezzola P. A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery. Ann Surg 2012; 256 925–33.
| A systematic review of the effectiveness, compliance, and critical factors for implementation of safety checklists in surgery.Crossref | GoogleScholarGoogle Scholar | 22968074PubMed |
[88] Greene SM, Reid RJ, Larson EB. Implementing the learning health system: from concept to action. Ann Intern Med 2012; 157 207–10.
| Implementing the learning health system: from concept to action.Crossref | GoogleScholarGoogle Scholar | 22868839PubMed |
[89] Porter ME. What is value in health care? N Engl J Med 2010; 363 2477–81.
| What is value in health care?Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3cXhs1Whs7nK&md5=10e7e4a8d7c7bb0f7d77d2210b804448CAS | 21142528PubMed |
[90] James BC, Savitz LA. How Intermountain trimmed health care costs through robust quality improvement efforts. Health Aff (Millwood) 2011; 30 1185–91.
| How Intermountain trimmed health care costs through robust quality improvement efforts.Crossref | GoogleScholarGoogle Scholar | 21596758PubMed |
[91] Pham HH, Ginsburg PB, McKenzie K, Milstein A. Redesigning care delivery in response to a high-performance network: the Virginia Mason Medical Center. Health Affairs 2007; 26 w532–44.
| 17623687PubMed |
[92] Bechtel C, Ness DL. If you build it, will they come? Designing truly patient-centered health care. Health Aff (Millwood) 2010; 29 914–20.
| If you build it, will they come? Designing truly patient-centered health care.Crossref | GoogleScholarGoogle Scholar | 20439880PubMed |
[93] Porter ME, Pabo EA, Lee TH. Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs. Health Aff (Millwood) 2013; 32 516–25.
| Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs.Crossref | GoogleScholarGoogle Scholar | 23459730PubMed |
[94] Caplan GA, Sulaiman NS, Mangin DA, Aimonino Ricauda N, Wilson AD, Barclay L. A meta-analysis of ‘hospital in the home’. Med J Aust 2012; 197 512–19.
| A meta-analysis of ‘hospital in the home’.Crossref | GoogleScholarGoogle Scholar | 23121588PubMed |
[95] Scott IA, Coory M, Wills R, Coory M, Watson MJ, Butler F, Waters M, Bowler S. Impact of hospital-wide clinical process redesign on clinical outcomes: a comparative study of internally versus externally led intervention. BMJ Qual Saf 2011; 20 539–48.
| Impact of hospital-wide clinical process redesign on clinical outcomes: a comparative study of internally versus externally led intervention.Crossref | GoogleScholarGoogle Scholar | 21385888PubMed |
[96] Newnham HH, Villiers Smit PD, Keogh MJ, Stripp AM, Cameron PA. Emergency and acute medical admissions: insights from US and UK visits by a Melbourne tertiary health service. Med J Aust 2012; 196 101–3.
| Emergency and acute medical admissions: insights from US and UK visits by a Melbourne tertiary health service.Crossref | GoogleScholarGoogle Scholar | 22304592PubMed |
[97] Ranasinghe I, Turnbull F, Tonkin A, Clark RA, Coffee N, Brieger D. Comparative effectiveness of population interventions to improve access to reperfusion for ST-segment-elevation myocardial infarction in Australia. Circ Cardiovasc Qual Outcomes 2012; 5 429–36.
| Comparative effectiveness of population interventions to improve access to reperfusion for ST-segment-elevation myocardial infarction in Australia.Crossref | GoogleScholarGoogle Scholar | 22647553PubMed |
[98] Fjaertoft H, Indredavik B, Lydersen S. Stroke unit care combined with early supported discharge: long-term follow-up of a randomized controlled trial. Stroke 2003; 34 2687–91.
| Stroke unit care combined with early supported discharge: long-term follow-up of a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 14576376PubMed |
[99] Jackson C, Tsai J, Brown C, Askew D, Russell A. GPs with special interests. Impacting on complex diabetes care. Aust Fam Physician 2010; 39 972–4.
| 21301683PubMed |
[100] Chai-Coetzer CL, Antic NA, Rowland LS, Reed RL, Esterman A, Catcheside PG, Eckermann S, Vowles N, Williams H, Dunn S, McEvoy RD. Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life. A randomized trial. JAMA 2013; 309 997–1004.
| Primary care vs specialist sleep center management of obstructive sleep apnea and daytime sleepiness and quality of life. A randomized trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXlsVers7k%3D&md5=cc420d8a34be19a71636070aa91e5f2aCAS | 23483174PubMed |
[101] Alexander JA, Bae D. Does the patient-centred medical home work? A critical synthesis of research on patient-centred medical homes and patient-related outcomes. Health Serv Manage Res 2012; 25 51–9.
| Does the patient-centred medical home work? A critical synthesis of research on patient-centred medical homes and patient-related outcomes.Crossref | GoogleScholarGoogle Scholar | 22673694PubMed |
[102] Emanuel E, Tanden N, Altman S, Armstrong S, Berwick D, de Brantes F, Calsyn M, Chernew M, Colmers J, Cutler D, Daschle T, Egerman P, Kocher B, Milstein A, Oshima Lee E, Podesta JD, Reinhardt U, Rosenthal M, Sharfstein J, Shortell S, Stern A, Orszag PR, Spiro T. A systematic approach to containing health care spending. N Engl J Med 2012; 367 949–54.
| A systematic approach to containing health care spending.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhtlChsLbE&md5=46b9156d02226c2c11ab3df2b47dcd46CAS | 22852883PubMed |
