Abstract
Appropriateness is a key concept in the evolving landscape of healthcare, especially with the change from fee-for-service reimbursement to value-based purchasing and reimbursement. Consequently, healthcare providers, leaders, and change agents must be comfortable with defining appropriate care, and then designing systems to both ensure patients receive appropriate care and to prevent the delivery of inappropriate care. This chapter discusses the problem of unexplained variation in clinical care delivery, associated health outcomes, and the high cost of healthcare delivery. Next, the chapter describes the various conceptualizations of appropriateness from the perspective of four key stakeholders: physicians, patients, payers, and researchers. These conceptualizations serve as a framework to illustrate how the various stakeholders define appropriateness of care, and how these different stakeholders develop and use appropriateness criteria to shape care delivery. Lastly, the chapter proposes a three-step process by which healthcare leaders can improve care by using appropriateness criteria, and uses examples from a hospital, a health system, and a state collaborative to illustrate this three-step process in action.
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Coffey, C.E., Nuckols, T.K. (2017). Assuring Appropriate Care. In: Sax, H. (eds) Measurement and Analysis in Transforming Healthcare Delivery. Springer, Cham. https://doi.org/10.1007/978-3-319-46222-6_4
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DOI: https://doi.org/10.1007/978-3-319-46222-6_4
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