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Value-based Care

Study | The high financial and human cost of quality metric reporting in hospitals

11 Aug, 2023 | 15:36h | UTC

The Volume and Cost of Quality Metric Reporting – JAMA (link to abstract – $ for full-text)

Author Interview: The Costs of Quality Reporting – JAMA


The Cost of “Quality” – Emergency Medicine Literature of Note

How John Hopkins spent $5m and 108,478 hours on quality reporting in one year – HealthLeaders

The cost of quality metric reporting – Becker’s Hospital Review


Study | Uncovering the potential overuse of laboratory tests by combining cost, abnormal result proportion, and physician variation

11 Aug, 2023 | 15:34h | UTC

Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients – BMJ Open Quality


Perspective | An AI-enhanced electronic health record could boost primary care productivity

9 Aug, 2023 | 15:36h | UTC

An AI-Enhanced Electronic Health Record Could Boost Primary Care Productivity – JAMA (free for a limited period)


What are effective strategies to reduce low-value care? An analysis of 121 randomized deimplementation studies

17 Jul, 2023 | 13:55h | UTC

What are Effective Strategies to Reduce Low-Value Care? An Analysis of 121 Randomized Deimplementation Studies – Journal of Healthcare Quality


AHA Policy Statement | Value-based payment for clinicians treating cardiovascular disease

13 Jul, 2023 | 13:13h | UTC

Value-Based Payment for Clinicians Treating Cardiovascular Disease: A Policy Statement From the American Heart Association – Circulation

News Release: Policy guidance offers strategies to shift to value-based health care and payment – American Heart Association

Commentary: AHA Reviews Value-Based Payment Systems and Proposes Next Steps – TCTMD


Cohort Study | Increased revision rates seen in shoulder replacement surgeries by surgeons with less than 10 procedures annually

27 Jun, 2023 | 13:48h | UTC

Summary: This prospective cohort study investigated the correlation between surgeon volume and patient outcomes after elective shoulder replacement surgeries. Utilizing data from 39,281 procedures performed by 638 surgeons in UK public and private hospitals between 2012-20, the study focuses on adults aged 18 years or older.

The results indicate a significant connection between a surgeon’s mean annual volume and risk of adverse patient outcomes. Surgeons performing fewer than 10.4 procedures per year demonstrated a significantly increased risk of revision surgery, with the hazard ratio being almost twice as high as that of the lowest risk surgeons. Higher mean annual surgical volume correlated with lower risks of reoperations, fewer serious adverse events, and shorter hospital stays.

These findings suggest the need for strategic resource planning in surgical services, with considerations given to surgeon’s annual procedure volume to improve patient outcomes after shoulder replacement surgery. It should be noted that the study was limited in scope to surgeries performed within the NHS and private hospitals in England. Furthermore, potential confounding factors like patients’ social circumstances, carer availability, or body mass index were not considered.

Article: Association between surgeon volume and patient outcomes after elective shoulder replacement surgery using data from the National Joint Registry and Hospital Episode Statistics for England: population based cohort study – The BMJ

Editorial: Surgeon volume and patient outcomes in shoulder replacement surgery – The BMJ

News Release: Patients do better when surgeon averages 10 + annual shoulder ops – BMJ Newsroom


M-A | Biosimilar and reference biologics in rheumatoid arthritis show equivalent results

15 Jun, 2023 | 14:47h | UTC

Therapeutic Equivalence of Biosimilar and Reference Biologic Drugs in Rheumatoid Arthritis: A Systematic Review and Meta-analysis – JAMA Network Open

Commentary: Adalimumab, Etanercept, Infliximab Biosimilars Show Clinically Equivalence to Biologics in RA – HCP Live


Saving time and money in biomedical publishing: the case for free-format submissions with minimal requirements

13 Jun, 2023 | 14:08h | UTC

Saving time and money in biomedical publishing: the case for free-format submissions with minimal requirements – BMC Medicine

Commentary: Revealed: the millions of dollars in time wasted making papers fit journal guidelines – Nature


RCT | Immediate vs. delayed sequential bilateral cataract surgery: non-inferior in safety, higher cost-effectiveness

6 Jun, 2023 | 14:41h | UTC

Safety, effectiveness, and cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (BICAT-NL study): a multicentre, non-inferiority, randomised controlled trial – The Lancet (link to abstract – $ for full-text)

News Release: Cataract surgery: two-sided treatment better than one-by-one approach – Maastricht University


Quality-improvement intervention | Impact of stopping preoperative screening for asymptomatic bacteriuria

2 Jun, 2023 | 12:29h | UTC

If you don’t test, they will not treat: Impact of stopping preoperative screening for asymptomatic bacteriuria – Antimicrobial Stewardship & Healthcare Epidemiology

Commentary: Hospital intervention reduces unnecessary screening, antibiotics for bacteriuria – CIDRAP


SR | Unclear evidence on the efficacy of case management in integrated care for frail elderly

31 May, 2023 | 13:50h | UTC

Case management for integrated care of older people with frailty in community settings – Cochrane Library

Summary: Case management programmes for older people living with frailty in the community – Cochrane Library


The future of cancer care at home: findings from an American Cancer Society summit

31 May, 2023 | 13:48h | UTC

The future of cancer care at home: Findings from an American Cancer Society summit: CA: A Cancer Journal for Clinicians


RCT | Morning discharge prioritization fails to shorten hospital stay or expedite orders

9 May, 2023 | 14:58h | UTC

Discharge in the a.m.: A randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay – Journal of Hospital Medicine

Commentary: “Discharge Before Noon”: Time to Jump Off the Bandwagon? – Physician’s First Watch


Position Statement | Telehealth policy, practice, and education

4 May, 2023 | 14:01h | UTC

Telehealth Policy, Practice, and Education: a Position Statement of the Society of General Internal Medicine – Journal of General Internal Medicine


Top POEMs (Patient-Oriented Evidence that Matters) of 2022 for choosing wisely in practice

27 Mar, 2023 | 13:30h | UTC

Summary: Top POEMs of 2022 for choosing wisely in practice are based on Canadian Medical Association member ratings. These recommendations promote evidence-based and cost-effective clinical practices while reducing unnecessary treatments and diagnostic procedures.

Key recommendations from the article:

  1. Hypnotic agents are effective for insomnia but have adverse effects; avoid benzodiazepines as the first choice for older adults.
  2. For type 2 diabetes in older adults, avoid medications causing hypoglycemia to achieve A1c <7.5%; moderate control is better.
  3. Postoperative opioids provide no better pain relief than nonopioids; avoid prolonged use beyond the immediate postoperative period.
  4. Arthroscopic debridement is not recommended as the primary treatment for knee osteoarthritis.
  5. Proton pump inhibitor (PPI) use is associated with an increased risk of gastric cancer, although the association is observational and does not imply causation. Use the lowest dose and duration possible.
  6. For children with community-acquired pneumonia, low-dose amoxicillin for 3 days is noninferior to high-dose for 7 days.
  7. White blood cells in urine do not equate to bacterial cells; avoid urine dip tests or cultures unless urinary tract symptoms are present.
  8. Avoid measuring vitamin D in low-risk adults as a routine test.
  9. Antidepressants should not be routinely used as first-line treatment for mild or subsyndromal depressive symptoms in adults.
  10. ACG guideline for GERD management: try discontinuing PPIs after an 8-week trial in patients with classic GERD symptoms & no alarming symptoms.
  11. British Society of Gastroenterology guidelines for IBS management: colonoscopy only for alarming signs or microscopic colitis risk.
  12. USPSTF advises against ASA initiation for primary prevention of cardiovascular disease in adults >60.


Top POEMs of 2022 for choosing wisely in practice – Canadian Family Physician

See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada


SR | Interventions to reduce repetitive ordering of low-value inpatient laboratory tests

27 Mar, 2023 | 13:22h | UTC

Interventions to reduce repetitive ordering of low-value inpatient laboratory tests: a systematic review – BMJ Open Quality


Study reveals overuse of surveillance colonoscopy in older adults with limited life expectancy

23 Mar, 2023 | 13:11h | UTC

Summary: This study investigated the association between estimated life expectancy, surveillance colonoscopy findings, and follow-up recommendations among older adults. The study utilized data from the New Hampshire Colonoscopy Registry and included adults over 65 who underwent colonoscopy for surveillance after prior polyps.

Life expectancy was estimated using a validated prediction model and categorized into three groups: less than 5 years, 5 to less than 10 years, and 10 or more years.

Out of the 9,831 adults included in the study, 8% had advanced polyps or CRC. Among the 5,281 patients with available recommendations, 86.9% were advised to return for a future colonoscopy. Surprisingly, 58.1% of older adults with less than 5 years of life expectancy were also recommended to return for future surveillance colonoscopy.

The study concluded that many older adults with limited life expectancy are still recommended for future surveillance colonoscopy. This data could help refine decision-making about pursuing or stopping surveillance colonoscopy in older adults with a history of polyps.

Article: Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults – JAMA Internal Medicine (link to abstract – $ for full-text)

JAMA Patient Page: What Should I Know About Stopping Routine Cancer Screening?


Commentary on Twitter


Analysis | Networks of care to strengthen primary healthcare in resource constrained settings

21 Mar, 2023 | 13:08h | UTC

Networks of care to strengthen primary healthcare in resource constrained settings – The BMJ


M-A | Low-intensity follow-up after cancer surgery does not reduce patient satisfaction or well-being

16 Mar, 2023 | 13:10h | UTC

Oncological surgery follow-up and quality of life: meta-analysis – British Journal of Surgery


An overview of systematic reviews and meta-analyses on the effect of medication interventions targeting polypharmacy for frail older adults

3 Mar, 2023 | 14:07h | UTC

Summary: This overview of published systematic reviews examined the effectiveness of medication reviews on managing polypharmacy in frail older adults. The overview identified 10 systematic reviews, which included 154 studies. Medication reviews were the most common intervention, and the evidence suggests that they help reduce inappropriate medication use in frail older adults, but their impact on frailty scores and hospital admission is unclear. Pharmacist-led medication interventions were the most common, reducing inappropriate prescriptions in various settings. Tools, such as clinical decision-making computer support tools, were also found to be effective. The evidence quality ranged from moderate to critically low, highlighting the need for further research to establish if interventions directed at polypharmacy could have an impact on frailty syndromes.

Article: An Overview of Systematic Reviews and Meta-Analyses on the Effect of Medication Interventions Targeting Polypharmacy for Frail Older Adults – Journal of Clinical Medicine


Physician-led medication reviews in polypharmacy patients treated with at least 12 medications in a type 2 diabetes outpatient clinic: a randomised trial – Diabetic Medicine

RCT | A deprescribing intervention reduced medication burden among older adults in post-acute care

Achieving sustainable healthcare through deprescribing of unnecessary medications: making sense of the evidence – Cochrane Library

Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis – Health Technology Assessment

Barriers and facilitators to deprescribing of cardiovascular medications: a systematic review – BMJ Open

A National Modified Delphi Consensus Process to Prioritize Experiences and Interventions for Antipsychotic Medication Deprescribing Among Adult Patients With Critical Illness – Critical Care Explorations

Deprescribing proton pump inhibitors – Australian Journal of General Practice

Medication reviews and deprescribing as a single intervention in falls prevention: a systematic review and meta-analysis – Age and Ageing

Optimizing Medication Use in Older Adults With Rheumatic Musculoskeletal Diseases: Deprescribing as an Approach When Less May Be More – ACP Open Rheumatology

Facing the challenge of polypharmacy when prescribing for older people with cardiovascular disease. A review by the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy – European Heart Journal – Cardiovascular Pharmacotherapy

Deprescribing in Older Adults with Cardiovascular Disease – Journal of the American College of Cardiology

Multimorbidity in Older Adults with Cardiovascular Disease – American College of Cardiology, Latest in Cardiology

Antihypertensive Deprescribing in Older Adults: a Practical Guide – Current Hypertension Reports

How-to guide for medication reviews in older adults with cancer: A Young International Society of Geriatric Oncology and Nursing & Allied Health Interest Group initiative – Journal of Geriatric Oncology

Deprescribing in Palliative Cancer Care – Life

Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review – Kidney360

Process evaluation of implementation strategies to reduce potentially inappropriate medication prescribing in older population: A scoping review – Research in Social and Administrative Pharmacy

AGA Clinical Practice Update on De-Prescribing of Proton Pump Inhibitors: Expert Review – Gastroenterology

Development of a Metric to Detect and Decrease Low-Value Prescribing in Older Adults – JAMA Network Open

The MedSafer Study—Electronic Decision Support for Deprescribing in Hospitalized Older Adults: A Cluster Randomized Clinical Trial – JAMA Internal Medicine

Quantifying Anticholinergic Burden and Sedative Load in Older Adults with Polypharmacy: A Systematic Review of Risk Scales and Models – Drugs & Aging

Deprescribing in palliative patients with cancer: a concise review of tools and guidelines – Supportive Care in Cancer

Prescribing practices, patterns, and potential harms in patients receiving palliative care: A systematic scoping review – Exploratory Research in Clinical and Social Pharmacy

A narrative review of evidence to guide deprescribing among older adults – Journal of General and Family Medicine

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens – The Lancet Health Longevity

Polypharmacy Management in Older Patients – Mayo Clinic Proceedings

Psychopharmacological Treatment in Older People: Avoiding Drug Interactions and Polypharmacy – Deutsches Ärzteblatt international

Eliminating Medication Overload: A National Action Plan – Lown Institute

International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action – Drugs & Aging

Common ED Medication Errors: Polypharmacy – emDocs

Current and future perspectives on the management of polypharmacy – BMC Family Practice

Routine deprescribing of chronic medications to combat polypharmacy – Therapeutic Advances in Drug Safety

Polypharmacy—an Upward Trend with Unpredictable Effects – Deutsches Ärzteblatt international

Clinical Consequences of Polypharmacy in Elderly – Expert Opinion on Drug Safety


Choosing Wisely in Cardiology | New ACC list of five things physicians and patients should question

28 Feb, 2023 | 14:03h | UTC

Summary: The American College of Cardiology (ACC) has released a list of “Five Things Physicians and Patients Should Question” in cardiology as part of the Choosing Wisely campaign, which encourages conversations between clinicians and patients about potentially unnecessary tests, treatments, and procedures. The list includes recommendations to:

  1. Avoid the routine use of invasive hemodynamic monitoring with pulmonary artery catheters in patients with uncomplicated acute decompensated heart failure.
  2. Avoid performing atrial fibrillation ablation for the sole purpose of discontinuing chronic anticoagulation.
  3. Avoid routine imaging stress tests or coronary CT angiography for the workup of palpitations or presyncope.
  4. Avoid obtaining a coronary artery calcium score in patients with known clinical atherosclerotic cardiovascular disease.
  5. Avoid obtaining routine serial echocardiograms for chronic heart failure if there has been no change in signs, symptoms, or management.

The recommendations are based on published national guidelines and aim to broadly represent the field of cardiology.

List: American College of Cardiology: Five Things Physicians and Patients Should Question – Choosing Wisely

Commentary: ACC Releases New List of Choosing Wisely Recommendations – American College of Cardiology

See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada


Perspective | Beware of overdiagnosis harms from screening, lower diagnostic thresholds, and incidentalomas

27 Feb, 2023 | 13:18h | UTC

Summary: This article discusses the concept of overdiagnosis and its relevance to clinical practice guidelines. Overdiagnosis is the diagnosis of a condition that, if unrecognized, would not result in symptoms or cause a patient harm during their lifetime, such as discovering a low-grade cancer that will never lead to symptoms at the end of life. But, unlike false positives, overdiagnosed individuals truly have the condition; they just don’t benefit from the diagnosis. Overdiagnosis can also result from lowering diagnostic thresholds for diagnosing a disease, which inflates diagnosis rates among patients and leads to recommendations for subsequent interventions without clear benefits. The article highlights the importance of providing accurate information to patients about the possibility and burden of overdiagnosis to inform shared decision-making and minimize the harms of screening interventions.

Article: Beware of overdiagnosis harms from screening, lower diagnostic thresholds, and incidentalomas – Canadian Family Physician


Editorial: Chance Encounters, Overdiagnosis, and Overtreatment – Clinical Orthopaedics and Related Research

Broadening risk factor or disease definition as a driver for overdiagnosis: A narrative review – Journal of Internal Medicine

Overdiagnosis: it’s official – The BMJ

Overdiagnosis: what it is and what it isn’t – BMJ Evidence Based Medicine

Overdiagnosis across medical disciplines: a scoping review – The BMJ Open

Too much medical care: bad for you, bad for health care systems – STAT News

Overdiagnosis: causes and consequences in primary health care – Canadian Family Physician

Five warning signs of overdiagnosis – The Conversation

What is overdiagnosed cancer? And why does it matter? – Croakey

Blame rising cancer overdiagnosis on ‘irrational exuberance’ for early detection – STAT

Preventing overdiagnosis and the harms of too much sport and exercise medicine – British Journal of Sports Medicine

Study shows that current definitions of chronic kidney disease overestimate the CKD burden in older individuals and results in overdiagnosis.

Opinion | More kids are being diagnosed with ADHD for borderline (yet challenging) behaviors. Our new research shows why that’s a worry

A food allergy epidemic… or just another case of overdiagnosis?

An epidemic of overdiagnosis: Melanoma diagnoses sky rocket


Innovative models of healthcare delivery: an umbrella review of reviews

27 Feb, 2023 | 12:37h | UTC

Innovative models of healthcare delivery: an umbrella review of reviews – BMJ Open


Health technology assessment of diagnostic tests: a state of the art review of methods guidance from international organizations

27 Feb, 2023 | 12:34h | UTC

Health technology assessment of diagnostic tests: a state of the art review of methods guidance from international organizations – International Journal of Technology Assessment in Health Care


Editorial | Top-down and bottom-up approaches to low-value care

15 Feb, 2023 | 16:08h | UTC

Top-down and bottom-up approaches to low-value care = BMJ Quality & Safety

Original Study: Evaluation of the NHS England evidence-based interventions programme: a difference-in-difference analysis – BMJ Quality & Safety


Commentary on Twitter


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