JAMA -- From Waste to Value in Health Care, February 6, 2008, Boat et al. 299 (5): 568

JAMA -- From Waste to Value in Health Care, February 6, 2008, Boat et al. 299 (5): 568:

"The United States ranks among the worst of industrialized countries for indicators of health such as infant mortality and life expectancy,1 despite spending $2 trillion annually on health care,2 more than any other nation per capita. However, higher health care spending does not correlate with higher quality of care or better patient outcomes.3-5 These sobering indicators suggest that an opportunity exists to close the value gap in the day-to-day delivery of health care by eliminating actions that impede optimal systematic performance, which result in less than perfect outcomes, extra work, or corrective work, otherwise described as waste.

Patient falls and decubitus ulcers represent waste in the form of 'never events' that create more costs and result in systemic dissatisfaction. Waste is illegible and incomplete prescriptions that consume technician, nurse, and pharmacist time and, at worst, risk the life of the patient. Waste is acute care hospitalization of patients with diabetes who received inadequate preventive care. Waste is failing to adopt evidence-based care. Waste accounts for 30% to 50% of health care spending.6-7

Over the last 20 years, quality has become a widely shared mantra in health care but with few efforts to systematically define the exact size and nature of the opportunity to improve value. This situation is somewhat analogous to when a physician determines that a patient is ill but does nothing more to diagnose or treat the patient. A better or more accurate approach to taking advantage of the opportunity would be to produce detailed problem statements that permit a locally driven but nationally connected set of interventions to close the value gap."

More about QI than cost, but they do mostly go hand in hand...

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