Should There Be Guidelines Surrounding Timing of Care?

| | Evidence Based Medicine, Utilization Review

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Practitioners turn to evidence-based guidelines to help them determine appropriate treatment for patients. However, there are currently no guidelines governing the timing for treatments. If implemented, guidelines for the timing of care could benefit patients, practitioners, and insurance companies alike.

The Case for Timing of Care Guidelines

Research suggests that the longer a claim is open, the more likely something will go wrong for the parties involved: patients, practitioners, and insurance companies.

Patients should receive the most effective treatments as soon as possible in order to have the best opportunities to recover as early as possible. However, the early stages of treatment often take longer than they should, meaning patients spend a prolonged period of time with palliative care that that runs up costs and exposure to habit-forming drugs before they receive the appropriate treatment.

Because patients respond better to treatment in the earlier stages of an injury or illness, practitioners should look to identify and administer the most effective treatments right away. A lack of timing guidelines often means that practitioners spend too much time trying to find effective treatments, rather than seeking second opinions or help from specialists. Thus, patients often receive the correct treatments later than they should.

The longer a claim is open, the more resources the insurance company must allocate to the claim. This time and manpower could be put to better use helping other patients receive timely care.

With timing of care guidelines, we could identify the best course of treatment quicker and more effectively. Practitioners could ensure that patients receive the right care early on in the process, when it matters most. Patients would be less likely to develop drug dependences, and insurance companies could make more efficient use of time and resources to help more patients receive timely care.

What Could Guidelines Look Like

To illustrate the case for timing guidelines, it may be useful to consider some concrete examples of what the guidelines could look like.

For non-specialists, timing guidelines could aim to prevent delayed referrals to specialists when needed. An example guideline could state, “if a patient has not made significant improvements in 4-6 weeks of treatment, then the treating doctor should refer the patient to a specialist.” Thus, treatment is not delayed, and the patient can recover more quickly under the care of a specialist.

For specialists, timing guidelines should focus on ensuring that the specialist takes the right course of action immediately. For example, if a specialist does not see improvement in a specified time frame, the specialist should seek out a second opinion, to avoid wasting time or applying ineffective treatments.

Consider a patient with a 10-year-old claim who has undergone two trigger finger releases on the left ring finger. The patient returns to the doctor, presenting a third occurrence of trigger finger in the left ring finger. Surgery is performed, and then it is discovered that an area of the finger had not been released in the previous two surgeries.

With timing guidelines, the patient may not have required three surgeries for the same minor condition. Instead, the specialist who performed the first surgery would obtain a second opinion when it became clear that the patient was not responding to the initial treatment.

Guidelines: A Good Idea, But Are They Plausible?

Though guidelines for the timing of care present clear benefits, some express concerns that they cannot be practically applied. They may be difficult to develop and implement, and the conditions of the guidelines can be hard to formulate – e.g., should patients be referred after failing to respond to six therapies or seven?

The question we must answer going forward is this: Can practical guidelines for the timing of care be created and implemented, or are such guidelines too cumbersome, vague, and ineffective?

Zenia Cortes, MD, Orthopedic Surgeon

Dr. Zenia Cortes brings her combined expertise in sports and orthopaedic medicine to UniMed Direct, along with insights from her experience in peer and utilization review.

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