In examining how to improve patient outcomes we turn to population medicine to develop treatment strategies.\u00a0 A powerful analysis of these efforts should include a Treatment Cascade.\u00a0 The cascade follows a cohort with the target condition to be treated.\u00a0\u00a0 In the analogy they all start out in kayaks at the top of the cascade and begin to shoot the rapids.\u00a0 Each drop-off in the cascade is defined by significant events that reduces the number of successful paddlers that will make it to the end, the bottom of the cascade \u2013 the desired medical outcome.\u00a0 \u00a0The number of kayakers who begin shooting the rapids define the denominator – the total eligible population.\u00a0 The number remaining at the end of each drop off, the numerators at each point along the cascade.\u00a0 With the numerator at each point and the original denominator a rate of success and loss can be determined.\u00a0 An examination of the events at each cascade drop off can lead to a strategy to reduce the loss at the most effective point(s) along the way and increase the rate of success in the end.<\/p>\n
Here is a common example of a treatment cascade in the medical literature for HIV infection in the US as of 2012.\u00a0 Of the people in the US infected with HIV is estimated that 82% are aware of their infection \u2013 they have been tested.\u00a0 The other 18% are unaware.\u00a0 This 18% is the first cascade loss.\u00a0 Notable, is the very large drop off seen between individuals diagnosed with HIV, linked to care but not retained in care.\u00a0 An additional 29% of the kayakers are lost at this cascade.\u00a0 So even with the highly effective treatment for HIV infection that is currently available at the end of the cascade of events only 25% of rafters have their HIV suppressed.<\/p>\n
Where the 18% at the top of the cascade that do not know if their infection may be an easy target (strategies for more testing), that group of rafters are subject to all of the downstream events that keep them from completing the run. \u00a0\u00a0Unless the reduction in the drop off is large the end result may be unimpressive.\u00a0 \u00a0Targeting the 29% that are lost to follow up care may have more people complete the run if you can arrive at a successful strategy.\u00a0 They have already negotiated the upper cataracts of the cascade without being lost and are left shoot the lower rapids to completion. \u00a0Remember, targeting this hydraulic hole will not restore the 18% lost at the first fall.<\/p>\n
Every medical condition or activity involving a series of sequential actions may be plotted on a treatment cascade.\u00a0 For Partnership HealthPlan medical offices participating in the Quality Improvement Program most all of its population based elements can be plotted on a cascade.\u00a0 By analyzing the way a cascade falls changes could be implemented to increase the number of individuals who successfully shoot the rapids to smooth water.<\/p>\n
Marshall Kubota, M.D.<\/p>\n","protected":false},"excerpt":{"rendered":"
In examining how to improve patient outcomes we turn to population medicine to develop treatment strategies.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2004","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\n