Variation in Hospital Resource Use: Systemic Predictors and Implications on Quality and Value
Research Project Vision: To promote attention to quality, appropriateness and accountability in hospital resource use.
This vision is underpinned by the following four strategies:
1. Establish resource use variation reports specific to departments and individual providers.
2. Associate resource use with quality outcomes that measure accessible, effective, safe, efficient and appropriate care.
3. Use system dynamics methodology to analyze the drivers of variation and improve our understanding of ways in which health care system policy and hospital structure are related to hospital resource use.
4. Guide the design and evaluation of initiatives to control ineffective or unnecessary use of hospital resources.
With rising health care costs, governments nationally and internationally are looking to reform the health care system to ensure sustainability. In Ontario, to ensure that future investments get results and improve patient health, the Ministry of Health and Long Term Care is now moving towards a more patient-centred payment policy to fund hospitals. Under the new payment system, more volume and funding will be allocated to hospitals that deliver evidence-based care and preferred outcomes. Therefore, there is pressing need to conduct research that demonstrates the value of hospital resource use in the care of patients and to identify quality measures that can be used in policies to promote appropriate, value-added use of resources.
A starting point to assess health services appropriateness is to measure variation in its use. It has been suggested that where large variation exists, there tends to be inappropriate use. Only after valid and reliable measures of variation of hospital resource use are produced can focus turn to appropriateness. The proposed research will also shed light on whether higher rates of hospital services produce better patient management and outcomes. It will also provide useful information for hospital administrators and policy makers aiming to promote accountability and increased value of hospital and health care resources.
Diagnostic imaging is a promising candidate for variation reporting. Diagnostic imaging helps triage illness severity and assesses the need for urgent intervention. Imaging also enhances diagnosis, guides medical treatment and helps determine whether a patient is clinically suitable for discharge. However, the decision to use a certain type of imaging, if any at all, is not always clear. Lack of clarity is partly due to the rapid advance in imaging technologies, leading to multiple modalities capable of use in a wide range of clinical situations. Despite the uncertainty of some testing patterns, diagnostic imaging is one of the fastest growing health care expenses in Canada and the U.S. In fact, rates have outstripped changes in demographics, disease prevalence and indications for use. This has prompted concerns of appropriateness and made it an increasingly visible target for efforts to control health care costs. The ability to reward only those imaging services that bring value to the care of patients would improve the effectiveness, efficiency and appropriateness of hospital care.
