Optimizing Health: Improving the Value of Healthcare Delivery

As health care costs soar there is increasing interest in examining what society and, particularly, patients receive in return for these expenditures. Optimizing Health brings together the best thinking from both sides of the Atlantic to explore these issues. It employs disciplinary perspectives from economics, ethics, philosophy, psychology, clinical practice, and epidemiology to explore various ways that value for patients have and can be determined. It concludes with a discussion of changes required in practice, research, and health care systems to maximize the outcomes received from the provision of medical care services from the patient’s perspective. The first section of the book provides theoretical perspectives from economics and systems thinking that help us to focus on how one might determine the value of medical care for patients. The next section considers the ethical and philosophical dilemmas that face developed countries in distributing medical care. How is justice served and evidence-based medicine employed to increase the value of medical care for patients? The section on psychology deals with measuring outcomes from the patient’s perspective and involving patients in medical decision making. Measuring quality of life and gaining valid quality of life information when patients cannot respond for themselves are important topics covered by these chapters. Other chapters consider ways that patients can become more involved in medical decision making with the expectation that this will increase the value of medical care for patients. A major section of the book about clinical practice discusses problems that can reduce the value to patients of medical care. These include overdiagnosis, aggressive treatments that do not result in better patient outcomes, findings that earlier diagnosis does not always result in better outcomes, and the extent of medical error in treatment. The final sections deal withcost-effectiveness analyses and applications of clinical epidemiology. The chapters include a number of original investigations and applications of new methodologies. All-in-all, the volume is must reading for practitioners, policy makers, and researchers who want to find in one place the state-of-the-art thinking and future directions of valuing medical care from the patient’s perspective.

Table of Contents:
Framework of CLINECS.- “CLINECS”: Strategy and Tactics to Provide Evidence of the Usefulness of Health Care Services from the Patient's Perspective (Value for Patients).- Systems View of Health Care.- Ethics and Philosophy.- Seeking Justice in Health Care.- Evidence-Based Medicine and Ethics: Desired and Undesired Effects of Screening.- Paradoxes of Medical Progress: Abandoned Patients, Physicians, and Nurses.- Theory Behind the Bridge Principles.- Psychology.- How to Measure Quality of Life.- New Instrument to Describe Indicators of Well-Being in Old Old Patients with Severe Dementia: Vienna List.- Patient Empowerment: Increased Compliance or Total Transformation?.- Shared Decision Making in Medicine.- Clinical Practice.- Overdiagnosis and Pseudodisease: Too Much of a “Good Thing”?.- Palliative Medicine Today: Evidence and Culture.- Medical Geography–Who Gets the Goods? More May Not Be Better.- Cancer Survival in Europe and the United States.- Patient Safety: What Does It Mean in the United States?.- Increasing Safety by Implementing Optimized Team Interaction: Experience from the Aviation Industry.- Evidence-Based Information Technology: Concept for Rational Information Processing in the Health Care System.- Economically Oriented Analyses.- Cost-Effectiveness Analysis: Measuring the Value of Health Care Services.- Cost-Effectiveness of Lung Volume Reduction Surgery.- Health Economic Evaluation of Adjuvant Breast Cancer Treatment.- Aims and Value of Screening: Is Perceived Safety a Value for Which to Pay?.- Clinical Epidemiology.- Evidence-Based Health Care Seen From Four Points of View.- Efficacy, Effectiveness, and Efficiency of Diagnostic Technology.- Reduced Mammographic Screening May Explain Declines in Breast Carcinoma Among Older Women.- “Fading ofReported Effectiveness” Bias: Longitudinal Meta-Analysis of Randomized Controlled Trials.- Clinical Research and Outcomes Research: Common Criteria and Differences.- Are the Results of Randomized Trials Influenced by Preference Effects? Part I. Findings from a Systematic Review.- Are the Results of Randomized Trials Influenced by Preference Effects? Part II. Why Current Studies Often Fail to Answer this Question.- Conclusion and Outlook.- Suggested Changes in Practice, Research, and Systems: Clinical Economics Point of View.