Finkler, S.A., and Ward, D.M. (2003, October). "The case of the use of evidence-based management research for the control of hospital costs." (AHRQ grant HS12081). Health Care Management Review 28(4), pp. 348-365.
Hospital managers generally don't use findings from evidence-based management research when making decisions designed to help control hospital costs. According to these researchers, the problem is two-fold: one, hospital managers do not seek out available evidence, and two, there is insufficient research to generate evidence for managers to use. They argue that the key to assessing cost containment is a framework that uses evidence to link three basic components: cost measurement, cost control, and assessment of value. However, there has been relatively little research on actual evidence-based decisionmaking for cost reduction in hospitals. The authors call for management research in the areas of cost containment that can provide hospital managers with practical information they can put to immediate use and that is designed and conducted in a way that allows for the assessment of effectiveness with respect to both cost containment and quality.
Washington, D.L., Bernstein, S.J., Kahan, J.P., and others (2003). "Reliability of clinical guideline development using mail-only versus in-person expert panels." (AHRQ grant HS07185). Medical Care 41(12), pp. 1374-1381.
Clinical practice guidelines quickly become outdated. One reason they might not be updated as often as needed is the expense of collecting expert judgment regarding the evidence. These investigators tested whether a less expensive, mail-only process could substitute for the standard in-person process normally used. To accomplish this, they performed a four-way replication of the appropriateness panel process for coronary revascularization and hysterectomy, conducting three panels using the conventional in-person method and one panel entirely by mail. All indications for the surgeries were classified as inappropriate or not (to evaluate overuse) and coronary revascularization indications were classified as necessary or not (to evaluate underuse). Similar results from the mail-only and in-person approach suggest a potential role for using an expert judgment process conducted entirely by mail to update guidelines.
Internet Citation:
Research Activities newsletter. February 2004, No. 282. AHRQ Publication No. 04-0031. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/feb04/
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