title: Evidence, Quality, and Waste: Solving the Value Equation in Neonatology.
abstract: Rising health care costs challenge governments, payers, and providers in delivering health care services. Tremendous pressures result to deliver better quality care while simultaneously reducing costs. This has led to a wholesale re-examination of current practice methods, including explicit consideration of efficiency and waste. Traditionally, reductions in the costs of care have been considered as independent, and sometimes even antithetical, to the practice of high-quality, intensive medicine. However, it is evident that provision of evidence-based, locally relevant care can result in improved outcomes, lower resource utilization, and opportunities to reallocate resources. This is particularly relevant to the practice of neonatology. In the United States, 12% of the annual birth cohort is affected by preterm birth, and 3% is affected by congenital anomalies. Both of these conditions are associated with costly health care during, and often long after, the NICU admission. We will discuss how 3 drivers of clinical practice in neonatal care (evidence-based medicine, evidence-based economics, and quality improvement) can together optimize clinical and fiscal outcomes.
authors.affiliation: Department of Pediatrics and Doernbecher Neonatal Care Center, Oregon Health and Science University, Portland, Oregon; Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; dukhovny@ohsu.edu.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Dukhovny
authors.affiliation: Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
authors.forename: DeWayne M
authors.initials: DM
authors.lastname: Pursley
authors.affiliation: Division of Neonatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; and.
authors.forename: Haresh M
authors.initials: HM
authors.lastname: Kirpalani
authors.affiliation: University of Vermont and Vermont Oxford Network, Burlington, Vermont.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Horbar
authors.affiliation: Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
authors.forename: John A F
authors.initials: JA
authors.lastname: Zupancic
mesh_terms: D019317:Evidence-Based Medicine; D017048:Health Care Costs; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000191:economics* / Q000592:standards*; D009359:Neonatology / Q000191:economics* / Q000592:standards*; D058996:Quality Improvement; D014481:United States