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Optimizing Health: Improving the Value of Healthcare Delivery (eBook)

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2007 | 2006
XXII, 314 Seiten
Springer US (Verlag)
978-0-387-33921-4 (ISBN)

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This book brings together the best thinking from both sides of the Atlantic to explore the issues surrounding soaring health care costs. 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. A major section of the book discusses problems that can reduce the value to patients of medical care. The volume is must read 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.



Franz Porzolt graduated from the University of Marburg School of Medicine and completed a postdoctoral fellowship on a grant from the Deutsche Forschungs-Gemeinschaft at the Princess-Margaret Hospital and Ontario Cancer Institute in Toronto. He received training in Internal Medicine, Hematology, and Medical Oncology at the Medical School of the University of Ulm, where he performed laboratory work and completed his doctoral thesis on 'Natural Killer Cells.' He established the Clinical Economics Group, which is involved in developing tools for assessing the (non- monetary) values of medical interventions from the patient's point of view. In 2000 he received a second appointment at the Ludwig-Maximilian University in Munich and a teaching contract with the Technical University in Munich to integrate Evidence-Based Medicine into the curriculum of medical students. He has worked with the Cochrane Collaboration, and currently has a contract to offer evidence based medicine training in the Alto Adige (Italy).

Robert M. Kaplan is Professor and Chair of the Department of Health Services and Professor of Medicine at UCLA. From 1997-2004, he was Professor and Chair of the Department of Family and Preventive Medicine at the University of California, San Diego. He is currently Chair-Elect of the Behavioral Science Council of the American Thoracic Society. Dr. Kaplan is the Editor- in-Chief of the Annals of Behavioral Medicine and Consulting Editor of four other academic journals. He is currently Co-Chairman of the Behavioral Committee for the NIH Women 's Health Initiative and a member of both the NHLBI Behavioral Medicine Task Force and the Institute of Medicine (IOM) National Academy of Sciences Committee on Health and Behavior. In addition, he is the Chairman of the Cost Effectiveness Committee for the NHLBI National Emphysema Treatment Trial (NETT).


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.

Franz Porzolt graduated from the University of Marburg School of Medicine and completed a postdoctoral fellowship on a grant from the Deutsche Forschungs-Gemeinschaft at the Princess-Margaret Hospital and Ontario Cancer Institute in Toronto. He received training in Internal Medicine, Hematology, and Medical Oncology at the Medical School of the University of Ulm, where he performed laboratory work and completed his doctoral thesis on "Natural Killer Cells." He established the Clinical Economics Group, which is involved in developing tools for assessing the (non- monetary) values of medical interventions from the patient's point of view. In 2000 he received a second appointment at the Ludwig-Maximilian University in Munich and a teaching contract with the Technical University in Munich to integrate Evidence-Based Medicine into the curriculum of medical students. He has worked with the Cochrane Collaboration, and currently has a contract to offer evidence based medicine training in the Alto Adige (Italy). Robert M. Kaplan is Professor and Chair of the Department of Health Services and Professor of Medicine at UCLA. From 1997-2004, he was Professor and Chair of the Department of Family and Preventive Medicine at the University of California, San Diego. He is currently Chair-Elect of the Behavioral Science Council of the American Thoracic Society. Dr. Kaplan is the Editor- in-Chief of the Annals of Behavioral Medicine and Consulting Editor of four other academic journals. He is currently Co-Chairman of the Behavioral Committee for the NIH Women 's Health Initiative and a member of both the NHLBI Behavioral Medicine Task Force and the Institute of Medicine (IOM) National Academy of Sciences Committee on Health and Behavior. In addition, he is the Chairman of the Cost Effectiveness Committee for the NHLBI National Emphysema Treatment Trial (NETT).

Foreword 5
Preface 6
Table of Contents 8
Contributors 12
Authors' Biographies 14
"CLINECS": Strategy and Tactics to Provide Evidence of the Usefulness of Health Care Services from the Patient's Perspective ( Value for Patients) 21
Systems View of Health Care 30
Seeking Justice in Health Care 35
Evidence-Based Medicine and Ethics: Desired and Undesired Effects of Screening 41
Paradoxes of Medical Progress: Abandoned Patients, Physicians, and Nurses 50
Theory Behind the Bridge Principles 56
How to Measure Quality of Life 63
New Instrument to Describe Indicators of Well- Being in Old Old Patients with Severe Dementia: Vienna List 76
Patient Empowerment: Increased Compliance or Total Transformation? 86
Shared Decision Making in Medicine 94
Overdiagnosis and Pseudodisease: Too Much of a "Good Thing?" 107
Palliative Medicine Today: Evidence and Culture 112
Medical Geography - Who Gets the Goods? More May Not Be Better 121
Cancer Survival in Europe and the United States 132
Patient Safety: What Does It Mean in the United States? 143
Increasing Safety by Implementing Optimized Team Interaction: Experience from the Aviation Industry 151
Evidence-Based Information Technology: Concept for Rational Information Processing in the Health Care System 166
Cost-Effectiveness Analysis: Measuring the Value of Health Care Services 177
Cost-Effectiveness of Lung Volume Reduction Surgery 191
Health Economic Evaluation of Adjuvant Breast Cancer Treatment 204
Aims and Value of Screening: Is Perceived Safety a Value for Which to Pay? 219
Evidence-Based Health Care Seen from Four Points of View 225
Efficacy, Effectiveness, and Efficiency of Diagnostic Technology 237
Reduced Mammographic Screening May Explain Declines in Breast Carcinoma Among Older Women 252
"Fading of Reported Effectiveness" Bias: Longitudinal Meta- Analysis of Randomized Controlled Trials 258
Clinical Research and Outcomes Research: Common Criteria and Differences 277
Are the Results of Randomized Trials Influenced by Preference Effects? Part I. Findings from a Systematic Review 285
Are the Results of Randomized Trials Influenced by Preference Effects? Part II. Why Current Studies Often Fail to Answer this Question 312
Suggested Changes in Practice, Research, and Systems: Clinical Economics Point of View 318
Index 324

Erscheint lt. Verlag 7.7.2007
Zusatzinfo XXII, 314 p.
Verlagsort New York
Sprache englisch
Themenwelt Mathematik / Informatik Informatik
Medizin / Pharmazie Allgemeines / Lexika
Medizin / Pharmazie Gesundheitswesen
Studium Querschnittsbereiche Prävention / Gesundheitsförderung
Sozialwissenschaften Politik / Verwaltung
Technik Medizintechnik
Schlagworte Anästhesie-Informations-Management-System • Cancer • Diagnosis • Economics • Efficiency • ethics • Evaluation • Health Care • Medicine • Psychology • Public Health • quality of life • School of Public Health • Sociology • Surgery
ISBN-10 0-387-33921-3 / 0387339213
ISBN-13 978-0-387-33921-4 / 9780387339214
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