Examkin

Soru

Zorluk: OrtaHealthcare Economics and Value-Based Care

A 58-year-old man presents to the emergency department with right calf swelling and discomfort that began 2 days ago. He recently returned from a 10-hour international flight. He has no significant past medical history and takes no daily medications. Vital signs are temperature 37.0°C (98.6°F), blood pressure 128/80 mmHg, pulse 82/min, and respirations 14/min. Room air oxygen saturation is 98%. The patient is ambulating well and his pain is controlled with oral acetaminophen. He lives with a supportive partner. Physical examination reveals a swollen, mildly tender right calf without erythema. A compression ultrasonography demonstrates an acute deep vein thrombosis in the right popliteal vein. Complete blood count and basic metabolic panel, including serum creatinine, are within normal limits. Which of the following is the most appropriate, cost-conscious next step in the management of this patient?

  1. Initiate a direct oral anticoagulant and discharge home with primary care follow-upCevap
  2. B
    Admit to the inpatient medical service and initiate continuous intravenous unfractionated heparin
  3. C
    Order a computed tomography pulmonary angiogram to rule out an asymptomatic pulmonary embolism
  4. D
    Discharge to a skilled nursing facility for daily administration of low-molecular-weight heparin
  5. E
    Order a comprehensive inherited thrombophilia panel to determine the optimal duration of anticoagulation

Cevap

The correct answer is to initiate a direct oral anticoagulant and discharge the patient home with outpatient follow-up.
The correct answer is to initiate a direct oral anticoagulant (DOAC) and discharge the patient home. High-value care and healthcare economics emphasize providing the most cost-effective care that maintains or improves quality and safety. For stable patients with an uncomplicated, provoked deep vein thrombosis (DVT), outpatient management is the standard of care. This patient is hemodynamically stable, has no oxygen requirement, possesses normal renal function, and has good social support at home. Transitioning directly to an outpatient setting with a DOAC avoids a costly hospital admission, decreases the risk of nosocomial complications, and aligns directly with value-based healthcare delivery models.

Adım Adım Çözüm

1
Identify the clinical condition
Uncomplicated, provoked acute lower extremity deep vein thrombosis (DVT)
The patient has a confirmed popliteal DVT with a clear provoking factor (long flight) and no signs of massive thrombosis or hemodynamic instability.
2
Evaluate the need for hospitalization based on clinical stability
Hospital admission is not indicated
The patient has normal vital signs, no oxygen requirement, normal renal function, good pain control, and adequate social support.
3
Select the most cost-effective, high-value management strategy
Outpatient management with a direct oral anticoagulant (DOAC)
Value-based care principles recommend outpatient management for stable patients with DVT to reduce unnecessary healthcare costs and prevent hospital-acquired complications.

Anahtar Kavram

High-value care for uncomplicated deep vein thrombosis involves outpatient management with direct oral anticoagulants, avoiding unnecessary hospital admissions and reducing overall healthcare costs.
Tahmini Süre:1m 0s
Bu soruyu puanla

Konular

Healthcare Economics and Value-Based Care

Bu konudan daha fazla soru