Following Choosing Wisely With Real-Time Support Tools Trimmed Hospital Stays, Cost in AJMC® Study
Healthcare savings foreseen with adoption of electronic health records have fallen short of expectations but adding clinical decision support tools could change that. A new study in
The study showed how integrating Choosing Wisely recommendations into real-time decision support tools improved care in the
The Cedars-Sinai research team, in its joint analysis with Optum Advisory Services, found:
- Total costs for patient encounters rose 7.3% when providers failed to follow Choosing Wisely alerts compared with when they accepted recommendations.
- Length of stay was 6.2% higher when providers ignored Choosing Wisely.
- Failing to follow Choosing Wisely increased the likelihood of readmission within 30 days (odds ratio [OR], 1.14; 95% CI, 0.998-1.31 for nonadherent vs adherent encounters).
- Failing to follow Choosing Wisely raised the risk of complications (OR, 1.29; 95% CI, 1.04-1.61 for nonadherent vs adherent encounters).
“Despite the publication of myriad evidence-based guidelines, providers continue to order tests, procedures, and medications for patients that may be not only be inappropriate, but sometimes also lead to worse health outcomes and higher costs for patients and third-party payers, such as employers, insurance carriers, Medicare, and Medicaid,” said study co-author
The findings suggest that adding alerts is the key to realizing the savings predicted from widespread adoption of electronic health records; however, the authors say they could not pinpoint a cause-and-effect relationship between the clinical outcomes and savings, so more research is needed.
“We recommend that health systems consider real-time [clinical decision support] interventions as a method to encourage improved adoption of Choosing Wisely and other evidence-based guidelines,” wrote the authors, led by Optum’s
“Incorporating decision support tools into electronic health records has consistently been among the top methods used in multicomponent interventions by the Choosing Wisely grant projects that successfully reduced unnecessary care,” said
In an accompanying editorial, AJMC® co-editor-in chief A. Mark Fendrick, MD, and
Fendrick and Budros noted that only 6 percent of the Cedars-Sinai providers followed all the alerts, so “there is significantly more work to be done.”
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