QI and Value-Based Care

Quality improvement and value-based care

Several researchers in our center focus on improving the quality of care and value of care for patients with esophageal conditions. In the United States, there is considerable waste in healthcare. Of the $3 trillion spent annually on healthcare in the United States, an estimated 10-30% of health spending consists of low-value care, or patient care with no net benefit to patients in specific clinical scenarios. Moreover, many of these health services can directly harm patients through side effects and complications.

Our team aims to measure and reduce low-value care at UCLA. Drs. John N. Mafi, MD, MPH and Catherine Sarkisian, MD, MSPH have been fortunate to find like-minded partners, co-investigator Folasade P. May, MD, PhD, MPhil and Division Chief Eric Esrailian, MD, MPH, who are passionate about improving quality and value in the UCLA Vatche & Tamar Manoukian Division of Digestive Diseases. Also key to endeavor is a multidisciplinary team from UCLA and RAND, including Cheryl Damberg, PhD, Bob Brook, MD, ScD, Reshma Gupta, MD, MSPH, Sam Skootsky, MD, and several others on how to measure and reduce low-value care. Specifically, we are leveraging the rich clinical data from the electronic health record, including natural language processing, in order to develop with highly valid and reliable “eMeasures” of low-value care.

We are currently evaluating several conditions for potential value measure development, such as low-value endoscopy for uncomplicated heartburn or dyspepsia. Our work in this area includes a collaboration with leaders nationally to address appropriate use of endoscopy at major medical centers.

In addition, we are evaluating how medications like proton pump inhibitors for acid reflux disease are prescribed at UCLA Health and designing interventions to assure that only patients who truly need to be taking these medications continue to take them

We will educate and engage frontline clinicians, provide customized performance feedback, and ultimately evaluate the impact on reducing low-value care. In turn, we hope to catalyze a broader movement to tackle low-value care both locally and nationally.