Patient Management, Quality of Care and Costs: Using Blood Management as a Paradigm
Richard K. Spence, M.D., MHA, FACS
Seventeenth and eighteenth century physicians were often known as philosophers, a name that reflected the approach to treatment they used. All too often medical practice was a one-size fits all approach. We understand these philosophies today as derivatives of empirical observation in a time when there was little else to guide medical practice and the measure of quality was patient survival, because of or in spite of treatment. Consider the distinguished American physician, Benjamin Rush, seeing clinical improvement in a patient with dropsy (congestive heart failure) after phlebotomy. He did not know that the blood letting had decreased her preload and relieved the strain on her failing heart, but the anecdotal evidence of clinical improvement was enough for him. Consider, then, the impact of Rush’s philosophy of blood letting on another of his patients, George Washington, who died from pharyngitis, aggravated by the loss of three-fifths of his blood volume through phlebotomy. In his case, the cure was most assuredly worse than the disease. These physician/philosophers can be forgiven for making the quantum leap from witnessing the benefit of blood letting in a few patients to assuming that it must be good for all patients, just as we hope our predecessors will forgive us for cutting into patients.
Unfortunately, the clinical practice of blood transfusion for many remains mired today in this history of anecdotal evidence, received knowledge and great expectations. The same can be said about the relationships among medical practice, clinical outcomes, cost and quality. Today, we assess results numerically – how many patients did you treat, how many died, how many infections did we have in the ICU, how much did we spend on a new drug or device - often without looking for relationships between practice components, costs and outcomes. Our scorecards may show trends but not interactions between how we practice and what happens to our patients.
Clinical Clarité LLC was created to address these issues by amalgamating information from the disparate data systems in health care that, at present, can’t “talk” to each other. Our collective experience in successful clinical blood management has convinced us that the same approach can achieve similar gains in quality and cost savings in multiple clinical areas. Our relational data engine provides answers to the “why did this happen,” “who shot John” and “what should we do to improve quality and reduce costs” questions we face every day. Our comparative assessments of your data to evidence-based sources of best practices can improve your understanding of what needs to be changed and how to change it.
A sacred adage of medical care inherited from the “ancients” is “First, Do No Harm.” It has never been enough just to avoid risk – we must also do the “right thing” to make our patients well. Our current healthcare system mandates that we attain these goals in the most effective and least expensive way. Clinical Clarité LLC can help you do this.