Resumo

ALWERS, Rolf. High value care (HVC) in Colombia. Internists must set the path. Acta Med Colomb [online]. 2016, vol.41, n.3, pp.191-197. ISSN 0120-2448.

In many countries there is evidence of increasing health spending. It is estimated that up to 30% of it is unnecessary and therefore represents waste of resources.

A great part of this waste corresponds to over-use of laboratory tests and diagnostic images that do not add quality to patient care. It is considered that in order that a health intervention may be of quality for the patient, its net benefit must be greater than the sum of its costs (direct and so-called "down stream") and the damage it net benefit may cause.

In an attempt to reduce waste in health, large part of which depends on the health professionals, several international organizations have developed strategies to identify those diagnostic tests that do not add value to patient care, regardless of cost. Campaigns like "Choosing Wisely" from the American Board of Internal Medicine (ABIM) and "High-value, cost-conscious care" of the American College of Physicians and the Alliance for the Academic Internal Medicine (AAIM for its acronym in English) promote identification of the 5 diagnostic tests that are more frequently ordered by their doctors within the different medical and surgical specialties, but that are considered not to add value to patient care and therefore should be discouraged. These tests thus identified are known as the "top 5". Patients should also be involved and informed of the little or no value that these tests represent for their health care.

In our country, the Colombia Chapter of the American College of Physicians (ACP) has formed a working group of medical optimal quality (MOC), as the initiative has been named in our country, responsible for its dissemination among different scientific societies and academic institutions at pre-and postgraduate level. Under the consideration that internal medicine physicians must lead this initiative in Colombia, work is being done on the most appropriate methodology that will allow identify a first group of diagnostic tests characteristic of Internal Medicine that are considered of little value (quality) in our environment. (Acta Med Colomb 2016; 41: 191-197).

Palavras-chave : High-value care; quality; top five; diagnostic tests; screening tests.

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