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ordered by colleagues and having access to the results give physicians the ability to avoid duplicate lab charges and make diagnoses more rapidly and reliably. The reduction in redundancies conserves the hospital’s resources, saves purchasers’ money and, ultimately, lowers premiums. These technologies and quality im- provement techniques will be essential to hospitals’ ability to create accountable care organizations (ACOs) and compete in the new marketplace. Comprehensive federal healthcare reform (Affordable Care Act) enacted in 2010 identifi es ACOs as a promising healthcare delivery structure that can improve the quality and cost effi ciencies of American healthcare. The model differs from previous attempts at hospital and physician economic alignment by focusing on providers instead of insurers or HMOs. All ACO functions have not been de- tailed by the new legislation. But initially they are described as a clinical integration of participating physicians and their af- fi liated hospitals that manages a defi ned Medicare population across the continuum of care. While numerous attributes for ACOs have been put forth, four primary

Comparative effectiveness research

From U.S. Department of Health & Human Services cer/draftdefi nition.html

Comparative effectiveness research is the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions. The purpose of this research is to inform patients, providers and decision makers, responding to their expressed needs, about which interventions are most effective for which patients under specifi c circumstances. To provide this information, comparative effectiveness research must assess a comprehensive array of health-related outcomes for diverse patient populations. Defi ned interventions compared may include medications, procedures, medical and assistive devices and technologies, behavioral change strategies and delivery

system interventions. This research necessitates the development, expansion and use of a variety of data sources and methods to assess comparative effectiveness.

functions are emerging. ACOs should: 1. Establish information interoperability to securely exchange clinical and patient information among authenticated individu- als and facilities. 2. Contain healthcare costs. 3. Objectively improve medical quality. 4. Financially reward M.D.s based on improved quality and cost-effi ciency out- comes.

William C. Mohlenbrock, M.D.

In the new ACO paradigm, providers will be expected to hold themselves ac- countable for their outcomes of care. For this reason, one of the most exciting new frontiers for data-driven accountability assessments comes at the organizational level, where the accountable care index (ACI) is an emerging standard for quality improvement.

Thomas M. Kish

Developed in 2008 to support value- based clinical decision making, ACI is a compilation of hospitals’ and medical staffs’ services and quality outcomes, trended over a three-year period. ACI examines clinically and fi nancially reliable indicators and provides powerful insights into the performance of an individual hos- pital and its medical staff. By comparing internal data to ACI’s industry-standard statistics, hospitals and M.D.s can identify specifi c areas for quality and cost-effi ciency improvements. Five industry-standard metrics comprise the ACI standard: resource consumption, risk-adjusted mor- bidity rates, risk-adjusted mortality rates, reductions in variation and the NHQM (national hospital quality measures). ACI uncovers statistically signifi cant clini- cal variations and provides insights as to initiatives for clinical and fi nancial improvements.

Collaborative, physician-directed best-practice improvements are the healthcare industry’s best insur- ance against the externally mandated cost-containment alternatives that are the hallmark of third-party payers and proposed government-based reforms. As history has proven, advancements in the healthcare fi eld rarely come from outside the profession. It’s up to provid- ers to be proactive in addressing their well-publicized quality and cost problems. ACI, electronic charting and other data-driven initia- tives can facilitate clinically reliable analyses of hospital medical records information. These tools, which allow results to be reviewed in consumer- and purchaser- friendly formats, will make collaborative partnerships between stakeholders, clinical quality improvement and medical cost containment a reality.


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