What does an “Appropriate" Procedure mean?

An appropriate procedure is one in which the expected health benefit (e.g. increased life expectancy, relief of pain, reduction in anxiety, improved functional capacity) exceeds the expected negative consequences (e.g. mortality, morbidity, anxiety, time lost from work) by a sufficiently wide margin suggesting the procedure is worth doing, regardless of cost.

Why is focusing on appropriateness important?

By focusing on appropriateness of care, we can assure that patients get the right care at the right time and avoid any unnecessary costs. Health providers across the country are increasingly focusing on better ways to assess and ensure that patients are receiving the most appropriate care. Methods for doing so include services often obtained in the primary care office such as lab work, preventative screenings, and medications, in addition to more involved procedures. As care becomes more complicated and specialized, it’s important to have a standardized approach to assess the most appropriate treatment. With many patients seeing multiple physicians and working with a team of clinicians, this can be challenging. A key component of this process includes making sure patients are well-informed and that their preferences are part of the decision making process. Not only is doing an inappropriate procedure harmful to patients and their families, it also contributes to the growing health care cost problem in our country.

What is PrOE?

One way that we assess appropriateness at Mass General Brigham is using a tool called Procedural Outcome Entry or PrOE for short. PrOE was developed at Massachusetts General Hospital and allows clinicians to assess the appropriateness of the procedure and assess the patient’s risks based on their individual characteristics (e.g. medical history, age, etc.). PrOE is currently being piloted across select practices across Mass General Brigham.

How does PrOE work?

Using the RAND method of appropriateness, physicians and researchers compile data from clinical guidelines and appropriate use criteria from specialty societies (like the American Society of Cardiology) and real clinical cases to develop a set of criteria to assess, along with physician expertise, whether the procedure is appropriate. One of the unique things about PrOE is that it has validated risk models built into the tool so that it can quickly provide patients with individualized information about their risks for the procedure. PrOE can provide specific information about the risk of getting an infection, heart attack, and other things like the likelihood of staying in the hospital for long periods of time.

What is Shared Decision Making?

Shared Decision Making is a process that allows patients and their health care team to work together to select the best medical test or treatment for the patient. Shared Decision Making aims to:

  • Engage the patient in the healthcare decision making process.
  • Provide accurate information about healthcare options and outcomes.
  • Tailor medical treatments to patients’ goals and concerns.

What are Decision Aids?

Decision Aids are tools to assist patients with the shared decision making process. Decision Aids are available as printed booklets, videos or online website links. These tools help patients:

  • Prepare for a medical visit
  • Learn about medical tests and treatments
  • Understand what research shows about benefits and risks of treatments
  • Hear from other patients who have faced a decision about medical tests and treatments
  • Think through goals and personal preferences

What are PROMs?

Patient Reported Outcome Measures are clinical questionnaires that ask about patients’ health and well being related to specific conditions like knee pain or back pain. These are valuable because they capture detailed information about symptoms and functional status and allow us to track these over time. One example is measuring knee pain or the ability to walk in someone who has arthritis in their knee. Typically, hospitals collect data on the big questions like how long you were in the hospital, were you readmitted, and mortality rates after surgery, but PROMs gives a much fuller picture of our patients’ well-being and progress before and after surgery.

Why don’t you include data for individual physicians?

The performance reflected in the scores published on this website result from the work of the entire care team, not just the individual responsible physician. Great outcomes don’t occur without the help of physical therapists, at home nurses, primary care providers, and many others. Also, our physicians frequently take on the most complicated and high-risk patients. Their patient outcome scores, despite their excellence, may appear inappropriately low even though they are providing more advanced care than anyone else. We do, however, track individual provider scores internally to monitor performance and uncover best practices. We use this knowledge to improve care for all our patients. We think our patients should feel confident that by choosing a provider who participates in Care Decisions, no matter who they initially choose, they will be guided to the most appropriate provider and receive the best possible care.

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