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An Advisory Board Company Expert on Evidence-Based Medicine and Clinical Performance Improvement

November 20, 2016
by Mark Hagland
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Dr. John Kontor of The Advisory Board discusses evidence-based medicine and clinical performance improvement

When it comes to sharing data, information, and insights with physicians around the principles and practices of evidence-based medicine, studies are finding that physician education can only do so much to improve patient care (and only for so long). John Kontor, M.D. was one of the speakers to address the subject at the chief clinical executive summit, held last month in Orlando, and sponsored by The Advisory Board Company, Washington, D.C. Dr. Kontor, executive vice president for consulting at The Advisory Board Company, spoke with Healthcare Informatics Editor-in-Chief Mark Hagland in October, just prior to his scheduled speech at that event.

In his interview with Hagland, Dr. Kontor referenced one large integrated health system in particular that has obtained exceptional results from reducing variation in care. For example, that health system’s leaders, by reducing variation in the care of percutaneous coronary intervention (PCI), have achieved $2.5 million in avoidable costs, and avoided 247 days per year of inpatient stays, and averted 9.27 deaths per year, all compared with other organizations that are in the top quartile nationwide of most expensive cases in the PCI area. Those kinds of results, Kontor argues, show that, when deployed and managed well, evidence-based medicine initiatives can document firm results. Below are excerpts from the interview that Dr. Kontor gave Hagland last month.

Tell me a bit about your current research and consulting in this area?

Let me start at a high level, in terms of what we’re seeing evolving across the industry. Much of what has driven our focus has been similar to what we’re seeing on the provider side of the industry, particularly with the evolution towards value-based purchasing models. There’s increasing recognition that the care that organizations are giving is still not achieving the quality outcomes that folks are hoping for, and certainly, as seen through a value lens, not worth the money that payers are spending. And that’s why evidence-based care delivery is emerging as such an important phenomenon.

We look at both broad and specific measures. One example is interventions around percutaneous coronary interventions (PCIs), or stents. In that focused area alone, most hospitals or small health systems even, have multi-million-dollar opportunities to reduce inappropriate spending as well as to improve outcomes.

Essentially, stents are overly broadly used? Or is there inadequate scrutiny of their use?

Yes, over-utilization generally, and the main issues more specifically are around drug-eluting versus bare metal stents. And there are pretty good guidelines available.

Drug-eluting stents are not justified over bare-metal stents in many situations, then, correct?

Yes, that’s correct. And as organizations move into value-based models, they begin to look at these areas—both in terms of resource utilization and quality outcomes. So clearly, we’re seeing an acceleration of organizational attention to this, both because of value-based purchasing, as well as bundles coming along, as well as PAMA [the Protecting Access to Medicare Act of 2014], the outpatient imaging regulations that are requiring—there are a couple of components of that—but it’s requiring organizations to essentially use decision support to pre-authorize decisions around high-cost imaging studies. There are specific requirements around decision support, and this is one of the areas where health systems are saying, aha! I see how decision support in real time can help drive out some of the inappropriate ordering.

So that’s influencing thinking around decision-making in areas such as stents?

That’s correct. What we’re seeing is sort of a J-curve around interest in decision support, as organizations go into EMR implementation. EMR vendors focus on this, and there’s some evidence in the literature stating that decision support can influence decision-making. So they’re doing excessive turning on of alerts. And then folks start shutting down decision support like mad—in some cases, they’re turning off all the alerts that providers see, which is not the right answer, either. But what we’re starting to see now as most health systems have done at least an initial implementation of an EMR, as providers get more comfortable with using an EMR, the health system leaders are starting to look for value, and so we’re seeing interest in evidence-based clinical decision support.

Tell me a bit about the different areas of interest you’re seeing?

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