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Optimizing Health: Improving the Value of Healthcare Delivery

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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 with cost-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.


Ronald Andersen


Wasserman Professor Emeritus of the Departments of Health Services and Sociology at the University of California School of Public Health in Los Angeles

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Table of Contents
Foreword Preface Contributors Authors Biographies
Framework of CLINECS
1
2
CLINECS: Strategy and Tactics to Provide Evidence of the Usefulness of Health Care Services from the Patients Perspective (Value for Patients) Franz Porzsolt and Robert M. Kaplan
Systems View of Health Care Robert M. Kaplan
Ethics and Philosophy
Ethics
3
4
Seeking Justice in Health Care Lawrence J. Schneiderman
EvidenceBased Medicine and Ethics: Desired and Undesired Effects of Screening Franz Porzsolt and Heike LeonhardtHuober
Philosophy
5
Paradoxes of Medical Progress: Abandoned Patients, Physicians, and Nurses Peter Strasser
v vii xiii xv
1
10
15
21
30
ix
x
6
Contents
Theory Behind the Bridge Principles Hans Russ, Johannes Clouth, and Franz Porzsolt
Psychology
Psychometrics
7
8
How to Measure Quality of Life Robert M. Kaplan
New Instrument to Describe Indicators of WellBeing in Old Old Patients with Severe Dementia: Vienna List Franz Porzsolt, Marina Kojer, Martina Schmidl, Elfriede R. Greimel, Jörg Sigle, Jörg Richter, and Martin Eisemann
Culture and Psychology
9
10
Patient Empowerment: Increased Compliance or Total Transformation? Susan B. Rifkin
Shared Decision Making in Medicine Hana Kajnar
Clinical Practice
Problems Often Overlooked
11
12
13
14
Overdiagnosis and Pseudodisease: Too Much of a Good Thing? Robert M. Kaplan
Palliative Medicine Today: Evidence and Culture E. Jane Maher
Medical GeographyWho Gets the Goods? More May Not Be Better Robert M. Kaplan
Cancer Survival in Europe and the United States Gemma Gatta
Quality and Safety
15
Patient Safety: What Does It Mean in the United States? Joseph E. Scherger
36
43
56
66
74
87
92
101
112
123
131
EvidenceBased Information Technology: Concept for Rational Information Processing in the Health Care System Horst Kunhardt
Contents
16
17
Applications
171
199
Health Economic Evaluation of Adjuvant Breast Cancer Treatment 184 Reinhold Kilian and Franz Porzsolt
146
xi
20
21
217
19
205
EvidenceBased Health Care Seen From Four Points of View Amit K. Ghosh, Dirk Stengel, Nancy Spector, Narayana S. Murali, and Franz Porzsolt
238
257
Clinical Research and Outcomes Research: Common Criteria and Differences Franz Porzsolt, Dirk Stengel, Amit K. Ghosh, and Robert M. Kaplan
26
25
Fading of Reported Effectiveness Bias: Longitudinal MetaAnalysis of Randomized Controlled Trials Bernhard T. Gehr, Christel Weiss, and Franz Porzsolt
Reduced Mammographic Screening May Explain Declines in Breast Carcinoma Among Older Women Robert M. Kaplan and Sidney L. Saltzstein
24
232
Clinical Epidemiology
CostEffectiveness of Lung Volume Reduction Surgery Robert M. Kaplan and Scott D. Ramsey
Increasing Safety by Implementing Optimized Team Interaction: Experience from the Aviation Industry Manfred Müller
CostEffectiveness Analysis: Measuring the Value of Health Care Services Robert M. Kaplan
Aims and Value of Screening: Is Perceived Safety a Value for Which to Pay? Franz Porzsolt, Heike LeonhardtHuober, and Robert Kaplan
Economically Oriented Analyses
18
Efficacy, Effectiveness, and Efficiency of Diagnostic Technology Dirk Stengel and Franz Porzsolt
157
23
22
xii
27
28
Contents
Are the Results of Randomized Trials Influenced by Preference Effects? Part I. Findings from a Systematic Review Dirk Stengel, Jalid Sehouli, and Franz Porzsolt
Are the Results of Randomized Trials Influenced by Preference Effects? Part II. Why Current Studies Often Fail to Answer this Question Franz Porzsolt and Dirk Stengel
Conclusion and Outlook
29
Suggested Changes in Practice, Research, and Systems: Clinical Economics Point of View Robert M. Kaplan and Franz Porzsolt
Index
265
292
298
304
http://www.springer.com/978-0-387-33920-7
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