7.7: Case studies
- Page ID
- 103490
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)Case 1: Clinical judgement
In dynamic healthcare delivery, there is requirement in balancing clinical judgement with evidence-based guidelines, practitioner beliefs, patient preferences, and avoiding low-value care to ensure patient-centred outcomes.
Dr Serena Hawthorne firmly believed in the necessity of a particular service despite it being identified and agreed as of low value within published clinical guidelines. A patient presented with chronic low back pain, and Dr Hawthorne recommended frequent magnetic resonance imaging (MRI) scans to monitor the progression of the condition. Despite the available evidence-based guidelines suggesting limited utility of frequent imaging for such cases, Dr Hawthorne insisted on its necessity to ensure comprehensive monitoring and timely intervention. The patient felt that this was appropriate and useful and agreed to meet the cost of any gap payments against social and voluntary health insurance or for total costs of the MRI monitoring.
Dr Hawthorne’s rationale stemmed from a deeply ingrained belief in personalised patient care and a commitment to thoroughness in diagnosis and treatment. Despite efforts by colleagues (general and specialist practitioners) to advocate for alternative, evidence-based approaches, Dr Hawthorne remained convinced of the service’s value, citing previous instances in her practice where early detection had led to successful interventions.
There is a complex interplay between clinical judgement, individual practitioner beliefs and evidence-based practice in healthcare delivery. This highlights the importance of ongoing education and dialogue within clinical teams to address variations in practice and promote the delivery of high-value care aligned with best evidence and patient-centred principles.
What approaches, over what timeframes, might be used to support development and change relating to individual practice in the context of new evidence-based practice guidelines?
Case 2: Residential aged care
Contemporary care involves integrating resident needs with evidence-based practices, reducing low-value care, and emphasising staff education, multidisciplinary collaboration and family engagement to enhance care quality.
At the Golden Haven Seniors’ Residence residential aged care facility, several residents were receiving low-value care, despite the facility’s commitment to quality service. At Golden Haven there was routine administration of unnecessary medications to manage mild symptoms of anxiety and insomnia. Despite evidence suggesting non-pharmacological interventions such as alternative sleep hygiene strategies, engagement with residents to partner with the view of establishing preferred sleep routines, cognitive behavioural therapy and environmental modifications as more appropriate first-line treatments, Golden Haven persisted in medication-centred approaches.
Golden Haven staff’s approach and justifications stemmed from a combination of factors, including time constraints, limited access to mental health specialists and a reliance on ‘quick’ pharmacological interventions. Additionally, family members occasionally requested medication to alleviate perceived distress in their family members.
Aged care facilities face significant challenges in balancing resident care needs with evidence-based practices. This highlights the importance of ongoing staff education, multidisciplinary collaboration and family engagement to ensure the provision of high-value, person-centred care in geriatric settings.
How can care organisations and services address practice changes when faced with limited resources (time, expertise, funding) to support carers in the provision of high-value care?
- Identify from publications an identified low-value healthcare activity. List all direct and indirect costs associated with that service. Estimate the total cost and identify opportunities for cost reduction through evidence-based alternatives.
- Compare patient outcomes from a low-value healthcare service to those from evidence-based alternatives. Analyse the cost-effectiveness and potential benefits of eliminating the identified low-value practices.