The American Hospital Association recently released a paper examining the drivers of health care costs and their contributing factors. "The Appropriate Use of Medical Resources" recommends a way to move forward that will place hospitals at the forefront of innovative change to reduce the use of specific non-beneficial services while improving health care overall.

This resource, developed with guidance from the AHA's Committee on Clinical Leadership, is an outgrowth of "Ensuring a Healthier Tomorrow," an AHA report that identified ways to improve care while achieving a sustainable level of spending.

The new report includes a list of five hospital-based procedures or interventions that should be reviewed and discussed by a patient and his or her physician prior to proceeding. They are:

  • Blood management in inpatient services;
  • Antimicrobial stewardship;
  • Inpatient admissions for ambulatory-sensitive conditions (for example, low back pain, asthma);
  • Elective percutaneous coronary intervention;
  • Use of the intensive care unit for imminently terminal illness (including encouraging early intervention and discussion about priorities for care in the context of progressive disease).

As medical societies, providers and others seek ways to drive appropriate use of medical resources, hospitals and systems can play an important role in guiding these efforts. To begin the discussion in your hospital and community, I encourage you to download and share this paper with your board, medical staff and community leaders and use the questions at the end to explore the issue together. The paper is available to members at

In the coming months, the AHA will roll out resources and share best practices for each of the five procedures or interventions from hospitals and systems that are already on this path. The AHA also will continue to work to reduce the barriers that hinder hospitals' efforts to provide the appropriate care at the appropriate time in the appropriate setting.

Katherine Keene ( is COG chair and a trustee of Salem (Ore.) Hospital.