Implications for Critical Care Delivery From Cleveland Health Quality Choice
Public accountability for outcomes derived from delivered health services is a growing expectation of consumers and purchasers. Many informed business leaders now advocate the use of outcomes data that are appropriately adjusted for case-mix in their selection of health-care providers. However, despite the wide geographic and temporal variability that exists in the processes and outcomes from care and the growing recognition of the need for valid data to assess health-care delivery systems, such data are generally not available in most health-care mar-kets. Moreover, typically no single corporate employer or purchaser has sufficient numbers of beneficiaries to independently influence the health-care delivery system or induce changes in practice pat-terns. Thus, in recent years, employer-driven coalitions to implement value-based health-care purchasing strategies have emerged in several healthcare markets.
In addition to the trends noted above, changing social priorities, such as the growth of patient autonomy in health-care decision-making, the growing realization that the application of high technology care must be balanced with the ability to improve quality of life, and the pressure to reshape health-care financing and limit total growth of hospital expenditures, have resulted in conflicting challenges for those specifically responsible for delivering critical care services Click Here canadian health & care mall. Addressing these challenges requires an enhanced ability to evaluate the incremental benefit of intensive care services on patient outcomes, as well as an understanding of the impact of changes in the organization and delivery of intensive care that are made in response to these pressures. Prognostic scoring and risk-adjustment tools that establish predicted rates for selected outcomes have been advocated as a marker for assessing quality performance within hospitals. Comparative ratios between observed and predicted outcomes (eg, hospital death rates) have been utilized to provide insight into areas of relative strength and weakness in clinical performance. In addition, the application of validated and methodologically sound prognostic models has been advocated as one basis for linking societal values with the provision of clinical care.