Evidence-based care helped rural Chinese public hospitals cut the length of average hospital stays, unnecessary services and prescription-drug spending without cutting overall hospital revenue, reports a study in the journal Health Affairs.
Results of the pilot project prompted Chinese officials to expand the use of evidence-based clinical pathways to attack what the study called "widespread overtreatment" in public hospitals.
Hospitals found themselves in a revenue crunch when the government significantly reduced financial support following economic reform, the report notes. In 2009, reform allowed hospitals to earn markups of up to 30 percent on certain services, including tests, imaging and prescriptions, to make up for losses from government-set fees in other areas. That led to overtreatment, particularly in high-margin services, the study notes.
The pilot study established pathways for treating 10 common diseases and conditions to improve quality of care, curb overtreatment and reduce patient out-of-pocket spending. The conditions included appendicitis, vaginal and C-section deliveries, stroke, pneumonia and coronary heart disease.
The pilot built flexibility into the clinical pathways, giving doctors discretion over elective services based on the patient's condition, the study noted. Case payment was fixed, though, regardless of whether electives services were provided.
Among the findings, unnecessary services for clinical-pathway patients were slashed by 20 percent, which also saved the patients and their insurers money. The clinical pathways also prompted better communications between patients and clinicians, improving both patient and provider satisfaction, the study found.
The length of hospital stay was slightly longer for some conditions, such as cerebral infarction, but the overall length of stay for clinical-pathway patients declined by one or two days.
In England, meanwhile, the National Health Service is developing more than 180 evidence-based quality standards to cover main pathways of care, reports Pulse.
It comes after the Department of Health ordered the NHS finance and competition regulator to launch a review into whether GPs are 'operating in the best interest of patients' and concerns about 'a lack of choice' of practices for patients.
A spokesperson said: 'Outcomes are the new currency for the NHS and will increasingly be the focus of accountability at every level of the system," a Health Services spokesperson told the publication. "But, driving improved outcomes requires us to out in place the right, evidence-based processes of care."
The NHS is trying to "develop an aligned set of levers and incentives which work together, rather than against one another, to improve patient care," the official said.
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