High-value care means providing the best care possible, efficiently using resources, and achieving optimal results for each patient.
General agreement suggests that there may be as much as 20% waste in using health care resources in the United States. Waste in health care refers to any services, products, or processes that do not help patients and are not necessary. This contributes to increasing health insurance premiums and increased out-of-pocket expenses. One way to reduce these costs is to improve the value of medical care delivery. There is room for improvement in care coordination, patient safety, administration of health care organizations, pricing, and overuse or inappropriate use of resources. Overuse may be common in laboratory testing, imaging examinations, or treatments that have questionable benefit. Medical schools and professional societies are now emphasizing the delivery of higher-value care. In the December 8, 2015, issue of JAMA, an article reports on how doctors can learn to deliver high-value care.
Although many tests and treatments may be used unnecessarily, the following 3 are very common and the changes outlined can improve the value of health care delivery.
Imaging (such as x-ray and computed tomography scans) within the first 6 weeks following the onset of low back pain usually does not change how patients are treated and is usually not necessary. Low back pain is the fifth most common reason for all physician visits. Imaging is commonly performed but is not usually helpful and poses a radiation risk.
When sinusitis lasts for less than 7 days, antibiotics should not be given. Sinusitis usually has causes other than the bacteria that antibiotics are used to treat. Unnecessary antibiotic use can have side effects such as allergic reactions or diarrhea. Sinusitis usually resolves on its own without the need for antibiotics.
Yearly electrocardiography, a test assessing the electrical and muscular function of the heart, is not necessary when there are no symptoms of heart problems or if someone has a low risk of heart disease. Screening for heart disease by routine electrocardiography does not improve long-term health.
Ask your physician questions, especially if tests or treatments are discussed.
What are the risks of tests or treatments?
How will this test or treatment help me?
Are there any other options beyond what was just recommended?
What would happen if I do not do anything?
Asking these questions helps with informed and shared decision making with the goal of having high-value care.
American College of Physicianshvc.acponline.org/patres.html
American Board of Internal Medicine Foundationwww.choosingwisely.org/gallery/videos/
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Spanish translations are available in the supplemental content tab.
Sources: Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513-1516.
Stammen LA, Stalmeijer RE, Paternotte E, et al. Training physicians to provide high-value, cost- conscious care: a review. JAMA. doi: 10.1001/jama.2015.16353.
Rudmik L, Soler ZM. Adult chronic sinusitis. JAMA. 2015;314(9):964.
Rudmik L, Soler ZM. Medical therapies for adult chronic sinusitis: a systematic review. JAMA. 2015;314(9):926-939.
Topic: Health Care Delivery
Aria A. Razmaria. High-Value Care. JAMA. 2015;314(22):2462. doi:10.1001/jama.2015.16990