Reducing Cost Through Standardization

Abstract

The drive for standardization of care within pediatrics based on medical evidence is gaining momentum among hospitals and providers. Initiated by care guidelines with origins in specialty societies, adoption of pathways is now being implemented in many settings. The keys to success of these algorithms in narrowing practice variation and their potential contribution to reducing utilization of unnecessary resources are not uniformly addressed in advance. Clinical guidelines are often not updated frequently to incorporate new evidence from the literature. Education of providers about the goals and process of pathways in advance may not be sufficient depending on the commitment of the clinical champions of the algorithms. Anticipatory modeling to identify potential barriers in the workflow that interfere with proper implementation of pathways is beneficial with the opportunity to refine the algorithm where appropriate. In order to confirm cost reduction, economic data points need to be defined in advance for comparisons between pre-implementation and post-implementation periods. It is possible that improved outcomes from narrowed practice variation may not always lead to cost reduction which should be reconciled by analysis of the data. Our experience with these limitations motivated our Department of Cardiology to seek a different approach to care pathways, standardized clinical and management pathways (SCAMPs) which engender algorithm design informed by existing evidence and experience of clinicians coupled with targeted questions that can be addressed by active data collection. Providers are free to depart from recommendations in the algorithm but must explain their reasons, an option that promotes participation. Data analysis combined with new medical evidence leads to iterative changes, greater standardization, and reduction of cost.