The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

Clinical Decision Making in the New Millennium: Are you Ready?

Patrick J. Dunne, MEd, RRT, FAARC Fullerton, California

The nation's health care delivery system is now at an important crossroads. After almost half a decade of relatively modest increases in health care premiums, health plans have begun to seek double digit increases for providing employer-sponsored health care benefits. Managed care organizations are likewise seeking substantial increases in monthly capitation rates from both governmental and private purchasers. In some instances when rate increase negotiations breakdown, HMOs threaten to, and in some cases actually do, exit certain markets. This forces enrolled members to scramble to find a suitable replacement, often with accompanying higher out-of-pocket expenses. Also, the country's Medicare population, growing ever so quickly and ever so steadily, is now demanding a prescription drug benefit. All of this uncertainty has resulted in health care becoming a key issue in this year's presidential campaign. Regrettably, this will likely do nothing more than foster myriad simplistic opinions and views from both parties about a highly complex and multidimensional problem.
Clinicians must recognize that, irrespective of what may or may not happen on the national scene, they will increasingly be expected (and often directly asked) to demonstrate that all care being provided is both necessary and appropriate. It follows that care that is to be provided will be expected to be delivered in the most cost-effective manner. In this regard, clinicians would be well advised to ensure their clinical practice closely parallels accepted guidelines, protocols and algorithms that have been widely promulgated and endorsed. This concept, described by some as "evidence-based medicine", is increasingly gaining favor and acceptance as a key strategy to ensure cost-containment without sacrificing quality.
Clinicians would also be well advised to recognize the growing phenomenon of consumerism in health care. Increasingly, due to the Internet, individuals are becoming much more informed about their medical conditions. Further, programs developed for chronic disease state management are predicated on the assumption that consumers will assume a more active role and sustained role in their own care. The better consumers are informed about, and periodically reminded of, their responsibilities for self-care, the better the outcomes will surely be. Cost-effective outcomes, when achieved in tandem with a high degree of customer satisfaction, bode well for all providers of health care services.
Respiratory therapists are extremely well suited to promote and practice evidence-based medicine. Respiratory therapists also possess the proven ability to embrace new technology, both in the technical/clinical arena as well as in the explosive management of information area. Moreover, respiratory therapists are quite adept when it comes to explaining complex therapeutic procedures to unknowing and often frightened patients. In a word, respiratory therapists are a "natural" when it comes to utilizing new technology and promoting consumerism in health care.
While it is impossible to predict the magnitude of the changes we will see in health care during the next several years, clinicians need to be proactive in today's world. Health care providers, individuals and institutions alike, who are serious about improving the nation's beleaguered health care system, should give a hearty embrace to evidence-based medicine, consumerism, and the novel application of new and exciting advances in information management technology.

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