What physicians don’t know about the risks of CT scans

July 26, 2011 by Leave a comment

By Alina Hsu

There’s been a lot of discussion recently about the risks of CT scans, partly in response to the new imaging data reported by Hospital Compare.

According to an article by Rita F. Redberg, M.D., M.Sc., in Engineering a learning healthcare system:  A look at the future:  Workshop summary,  (p. 128) “[an estimated] 2 percent of all cancers in the United states are attributable to radiation from CT scans, and…some 3 million additional cancers can be expected in the next decade because of increased use of CT scans.”  Further, the increased use of CT scans has not been associated with decreases in mortality or improved health outcomes.  According to the FDA, CT screening is also associated with false positives, which may necessitate costly, painful, invasive and unneeded follow-up procedures that may themselves present additional risks.  The incremental increase in cancer risk for an individual is very small compared to the baseline risk, but at a population level there is reason for concern.

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Triple Aim: Impossible dream, or bold new reality?

July 26, 2011 by Leave a comment

By Alina Hsu

While many hospitals and healthcare providers are still struggling to provide care that is safe, effective, patient-centered, timely, efficient and equitable, IHI has raised the bar.  The next step is the Triple Aim:

  • Improve the health of the population;
  • Enhance the patient experience of care (including quality, access, and reliability);
    and
  • Reduce, or at least control, the per capita cost of care.

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Play the Health Policy (Simulation) Game

July 26, 2011 by 1 Comment

by Alina Hsu

If payers cut reimbursement rates, what is the effect on healthcare cost over time?  On morbidity and mortality?

How about if we improve quality but make no other changes to the system?

Or if we simply move to universal coverage?

What if we try combinations of interventions?

HealthBound, a simulation game available on the CDC website, is based on a system dynamics model of causal relationships between components of the US healthcare system, including outcome measures.  Models are simplified and abstracted representations of complex realities.  For complex systems, especially considering unintended consequences and time lags between interventions and results, it can be difficult or impossible to intuit what the results will be.  The only ways we can learn about the results are by implementing changes in the actual systems, or by running simulations.  When the risks or costs of making changes in the actual systems are very high, we can experiment with various options and use what we learn to guide policy.  Interventions in the real world also don’t permit us to go back and try something different.  HealthBound also provides a neutral,  consistent framework for considering alternative approaches to healthcare reform.

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