Value-based Care
Perspective | Beware of overdiagnosis harms from screening, lower diagnostic thresholds, and incidentalomas
27 Feb, 2023 | 13:18h | UTCSummary: 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.
Related:
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
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 | UTCInnovative 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
Editorial | Top-down and bottom-up approaches to low-value care
15 Feb, 2023 | 16:08h | UTCTop-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
In this editorial, @andreapatey & @christinesoong discuss combining top-down ⬇️ and bottom-up ⬆️ approaches to effectively de-implement and reduce low-value care. https://t.co/mYJHkkJpSk
— BMJ Quality & Safety (@BMJ_Qual_Saf) February 10, 2023
SR | Cost measurement in value-based healthcare
15 Feb, 2023 | 15:46h | UTCCost measurement in value-based healthcare: a systematic review – BMJ Open
SR | Which interventions decrease ED attendances or hospital admissions from long-term care facilities?
6 Feb, 2023 | 13:04h | UTC
Commentary from the author on Twitter (thread – click for more)
🚨 FIRST PUBLICATION: Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review. #generalpractice #gp #research https://t.co/p53a3RnPyc
— Ben Searle (@bsearle92) February 3, 2023
Choosing Wisely | Five things physicians and patients should question in general internal medicine
2 Feb, 2023 | 15:08h | UTCSociety of General Internal Medicine: Five Things Physicians and Patients Should Question
Commentary: Patients don’t need to be ‘checked for everything’ – Northwestern University
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Review | Choosing Wisely in pediatric healthcare
2 Feb, 2023 | 15:07h | UTCChoosing Wisely in pediatric healthcare: A narrative review – Frontiers in Pediatrics
Related:
Choosing Wisely: Nine pediatric otolaryngology recommendations.
Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value.
Five things clinicians and patients should question in Pediatric Cardiology
Choosing Wisely in Pediatric Hematology: Five Things Physicians and Patients Should Question
Choosing Wisely in Pediatric Surgery: Five Things Physicians and Patients Should Question
New Choosing Wisely List: American Academy of Pediatrics – Section on Rheumatology
Choosing Wisely: Committee on Infectious Diseases and the Pediatric Infectious Diseases Society
Choosing Wisely: Section on Nephrology and the American Society of Pediatric Nephrology
New Choosing Wisely Lists in Pediatrics: Things Physicians and Patients Should Question
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
M-A | Effectiveness of outpatient geriatric rehabilitation after inpatient geriatric rehabilitation or hospitalization
15 Jan, 2023 | 19:48h | UTC
Choosing Wisely | Five things physicians and patients should question in the practice of pediatric emergency medicine.
5 Dec, 2022 | 00:22h | UTCSee complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Opinion | Minimizing administrative harm: a key step to improving health care.
29 Nov, 2022 | 14:21h | UTCMinimizing administrative harm: a key step to improving health care – STAT
Strategies for de-implementation of low-value care—a scoping review.
1 Nov, 2022 | 12:12h | UTCStrategies for de-implementation of low-value care—a scoping review – Implementation Science
Cohort Study | A collaborative home-based palliative care intervention for patients with heart failure reduced the risk of dying in the hospital.
13 Oct, 2022 | 13:37h | UTCCommentary: Home-Based Palliative Care for Heart Failure May Cut Risk for Dying in Hospital – HealthDay
Commentary on Twitter
Patients who received home-based, interdisciplinary palliative care were more likely to die at home than in hospital, compared to those who received usual care: https://t.co/JsLvANgcPK@kieranlquinn @PTanuseputro @sarina_isenberg #PalliativeCare #HeartFailure pic.twitter.com/6rOPtYQw2h
— CMAJ (@CMAJ) September 26, 2022
Viewpoint | Using behavioral economics to decrease operating room costs and promote better surgeon accountability.
29 Sep, 2022 | 13:28h | UTCUsing Behavioral Economics to Decrease Operating Room Costs and Promote Better Surgeon Accountability – JAMA Surgery (free for a limited period)
Perspective | Same-day discharge after minimally invasive colectomy.
29 Sep, 2022 | 13:27h | UTCSame-Day Discharge After Minimally Invasive Colectomy – JAMA Surgery (free for a limited period)
Study shows that same-day home recovery for benign foregut surgery is safe and feasible for most patients.
23 Sep, 2022 | 13:07h | UTCSame-Day Home Recovery for Benign Foregut Surgery – JAMA Surgery (link to abstract – $ for full-text)
Commentary on Twitter
Same-day home recovery is feasible, safe, and effective and may become common practice for the majority of benign foregut surgical procedures. https://t.co/vrYvfiXm5r #Research
— JAMA Surgery (@JAMASurgery) September 16, 2022
Cluster RCT | Effects of real-time prescription benefit recommendations on patient out-of-pocket costs.
19 Sep, 2022 | 12:47h | UTCEffects of Real-time Prescription Benefit Recommendations on Patient Out-of-Pocket Costs: A Cluster Randomized Clinical Trial – JAMA Internal Medicine (free for a limited period)
Invited Commentary: Real-time Prescription Benefit Tools—The Promise and Peril – JAMA Internal Medicine (free for a limited period)
Commentary on Twitter
Real-time Prescription Benefits (RTPB) uses patient out-of-pocket (OOP) cost to recommend lower-cost med alternatives to prescribers. In a RCT, RTPB reduced med OOP costs by 11%, though recommendations were only made for a small proportion of orders. https://t.co/xXviGvnbKw pic.twitter.com/naeciB3CDg
— JAMA Internal Medicine (@JAMAInternalMed) September 12, 2022
Review | The hidden pandemic: the cost of postoperative complications.
6 Sep, 2022 | 14:13h | UTCThe Hidden Pandemic: the Cost of Postoperative Complications – Current Anesthesiology Reports
Incorporating productivity loss in health economic evaluations: a review of guidelines and practices worldwide.
1 Sep, 2022 | 11:41h | UTC
Systematic Review | Interventions to reduce computed tomography usage in the emergency department.
24 Aug, 2022 | 13:54h | UTC
RCT | Antiseptic skin agents to prevent surgical site infection after incisional surgery.
8 Aug, 2022 | 11:54h | UTCAntiseptic Skin Agents to Prevent Surgical Site Infection After Incisional Surgery: A Randomized, Three-armed Combined Non-inferiority and Superiority Clinical Trial (NEWSkin Prep Study) – Annals of Surgery (link to abstract – $ for full-text)
Related:
Cochrane Collection | Achieving sustainable healthcare through deprescribing of unnecessary medications: making sense of the evidence.
8 Aug, 2022 | 11:50h | UTC
Viewpoint | Deimplementation of low-value care in surgery.
4 Aug, 2022 | 14:43h | UTCDeimplementation of Low-Value Care in Surgery – JAMA Surgery (free for a limited period)
M-A | Costs of multimorbidity.
20 Jul, 2022 | 12:06h | UTCCosts of multimorbidity: a systematic review and meta-analyses – BMC Medicine
Related:
Systematic review of high-cost patients’ characteristics and healthcare utilization – BMJ Open
Multimorbidity: a priority for global health research – The Academy of Medical Sciences
The global burden of multiple chronic conditions: A narrative review – Preventive Medicine Reports
Redesigning Care for High-Cost, High-Risk Patients – Harvard Business Review
Multimorbidity: clinical assessment and management – NICE Guideline
Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs
Better Care for People with Complex Needs – Institute for Healthcare Improvement
Comparison of strategies to conserve iodinated intravascular contrast media for computed tomography during a shortage.
10 Jun, 2022 | 11:21h | UTCComparison of Strategies to Conserve Iodinated Intravascular Contrast Media for Computed Tomography During a Shortage – JAMA (free for a limited period)
News Release: Amid Global Shortage, Study Shows How to Cut Contrast Dye Use 83% – University of California, San Francisco (UCSF)
Commentary on Twitter
This modeling study estimated that intravenous contrast use for CT scans could be reduced by approximately 80% by using a combination of dose-reduction strategies. https://t.co/hlnvkdEECS
— JAMA (@JAMA_current) June 9, 2022