Implications of Regional Differences in Spending

Franklin Gaylis

doi:10.7326/0003-4819-140-2-200401200-00024

Letters |20 January 2004

Implications of Regional Differences in Spending

Franklin Gaylis, MD

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TO THE EDITOR:

Commenting on the articles by Fisher and colleagues (which suggest that greater medical expenditure does not necessarily correlate with improvements in health outcomes) (1, 2), Dr. Wilensky (3) appropriately concluded that “We need to find ways to encourage better practices … and more thought about how to reward physicians who practice high-quality conservative medicine. Today is none too soon to begin.” This statement is right on the mark and needs careful consideration.

We can deal with the issue of encouraging better medical practice by changing the process of medical treatment delivery. That which constitutes necessary treatment is readily available in the form of clinical practice guidelines developed by the experts who have sifted out the best of evidence-based medicine. How to implement such practices constitutes the major challenge. Our group contends that the integration of clinical guidelines into standardized orders potentially will lead to better medical practice. We have used evidence-based standardized medical orders with much success, including better clinical outcomes and reduced cost. The development of such “tools” requires a committed group of physicians, nurses, and administrators working in concert. Such order sets have the potential to prompt physicians to practice the best of evidence-based medicine. Achieving success with such approaches requires a culture change by physicians and a coordinated effort by physician leaders to gain the “buy-in” of the physician body.

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2004 American College of Physicians

Letters |20 January 2004

Implications of Regional Differences in Spending

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Letters |20 January 2004

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