"We need to continually examine our practices to determine how best we can continue to provide high-quality patient care in a cost-effective manner," lead author Frederick Kofi Korley, MD, of the department of emergency medicine at Johns Hopkins University in Baltimore, said in an interview with HealthLeaders.
A. Mark Fendrick, co-director of the University of Michigan's Center for Value-Based Insurance Design in Ann Arbor, agreed, saying that such an examination will require coming to terms with an acceptable miss rate.
"What seems to be absent is a transparent discussion examining the tradeoffs between the clinical and cost implications of increased use and an unwillingness to miss a potentially treatable condition," he said. "We do not have the resources to be sure in every instance that the patient does not have a treatable condition."
The JAMA findings align with findings of research Fendrick and his colleagues published last year in which they concluded that CT scans in dizziness presentations should "be a target for efforts to optimize the effectiveness and efficiency of care."
The message is the same for the JAMA study: "What we try to do in VBID is to be as clinically nuanced as possible," Fendrick explains. A severe concussion is different from an ankle injury. "The value of a clinical service depends on the indication and the patient receiving it."
That approach appears to be gaining traction. "I am very optimistic that the multi-billion dollar investment in comparative-effectiveness research and, more importantly, health information technology, will allow for the development of real-time clinical decision support tools that will allow increased use of these services when they are truly beneficial, and a decreased use when they are less so."