Patients the winners in evidence based healthcare
Medibank Private has released new data indicating a greater understanding and application of clinical evidence to medical decision making would lead to improved health outcomes while saving costs.
An analysis of the almost 9,000 hip and knee replacements covered by Medibank Private during the 2008 calendar year shows significant variation in clinical practice - between states, between hospitals and between individual doctors. Whilst there are reasons about why particular devices may not be clinically suitable for some patients, the data clearly suggest there is room for improvement in evidence-based practice.
Apart from the human cost, Australia's health system bears a high financial cost from this variation in care. Data collected by the Australian National Joint Registry concludes that expensive, recently approved prostheses do not necessarily have improved outcomes for patients despite the extra cost.
However Medibank Private's data indicate these findings do not always inform clinical practice. Comparing the cost of hip prostheses used by individual surgeons reveals some consistently use devices costing in excess of $10,000, while others with comparable patient profiles use such high cost items sparingly. If clinical practice was consistent and in-line with evidence savings of up to 20% could be achieved and health outcomes improved.
It is not just health budgets that feel the impact of variations in clinical practice. Despite there being a proven no-gap device available in every case, 40% of surgical procedures involving a prosthesis use a device where a gap can be charged, meaning individual consumers are directly feeling the impact of inappropriate use of technology.
According to Medibank's Chief Executive Officer of Private Health Insurance, Bruce Levy, adoption of evidence driven clinical best practice would reduce the human and financial cost that stems from the wide variation in care.
"While there is agreement that technology can deliver real benefits to patients, the challenge is to ensure that these benefits are delivered appropriately to all patients in a consistent manner. We need to ask why we see such a wide variation in clinical practice.
"For example, national data shows almost 80% of knee replacements performed in Queensland use a cemented type prosthesis which has been shown to have lower revision rates. Yet just over the border in New South Wales, which has a similar patient profile as Queensland, cemented designs are used in just over 40% of surgeries.
"On a larger scale Australia has more knee replacements than comparable countries. Are Australians so different to people from other countries that such a variation is clinically necessary? Or is this a reflection of inconsistent application of best practice?
"Sweden and Norway, which have better outcomes for hips and knee surgery, use a smaller number of proven prostheses and more cemented than non-cemented designs. Maybe we should consider this approach to achieve better outcomes for Australians.
"Health Insurers want to purchase high quality care for their members. At Medibank, we will continue to drive appropriate and effective care through our purchasing, and to work with hospitals and doctors to improve the uptake of evidence-based practice," Mr Levy said.
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