Value-based Care
Countering cognitive biases in minimizing low value care
12 May, 2017 | 19:34h | UTCReview: Countering cognitive biases in minimizing low value care – The Medical Journal of Australia (free)
“How cognitive bias affects clinical decision making and what to do about it. Well written & useful” (RT @carissa_bon and @JulieLeask see Tweet)
8 things that excellent hospital doctors do
5 May, 2017 | 20:27h | UTCFirst opinion: 8 things that excellent hospital doctors do – STAT News (free)
Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing
4 May, 2017 | 20:14h | UTCAssociation Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing – JAMA (link to abstract – $ for full-text)
Commentaries: Doctors Prescribe More Generics When Drug Reps Are Kept At Bay – NPR (free) AND Limiting Interactions with Pharma Reps Cuts Brand Name Drug Prescriptions – Physician’s First Watch (free)
After Knee or Hip Replacement, No Place Like Home
27 Apr, 2017 | 16:28h | UTCAfter Knee or Hip Replacement, No Place Like Home – The New York Times (10 articles per month are free)
See also: Time to Rethink Inpatient Rehab After Knee Replacement? – The Rheumatologist (free)
Original article abstract ($ for full-text): Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial – JAMA (free)
The NYT commentary talks about the futility of some interventions currently used to postpone surgery and about the benefits of outpatient rehabilitation.
Relationship between hospital ward design and healthcare-associated infection rates
25 Apr, 2017 | 15:46h | UTCRelationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis – Antimicrobial Resistance & Infection Control (RT @brhospitalist and @PreetiNMalani see Tweet)
Single-patient rooms and easily accessible hand rub dispensers located near the patient’s bed are the most effective measures.
Caring for High-Need, High-Cost Patients
24 Apr, 2017 | 15:30h | UTCPerspective: Focusing on High-Cost Patients — The Key to Addressing High Costs? – NEJM Catalyst (free) (RT @brhospitalist)
Related commentaries: Caring for High-Need, High-Cost Patients — An Urgent Priority – New England Journal of Medicine (free) AND Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs (free)
Playbook: Better Care for People with Complex Needs – Institute for Healthcare Improvement (free)
Why Physician Burnout Is Endemic, and How Health Care Must Respond
24 Apr, 2017 | 15:24h | UTCSurvey and commentaries: Why Physician Burnout Is Endemic, and How Health Care Must Respond – NEJM Catalyst (free)
Increased in clerical burden seems to be one of the leading causes, heavily influenced by expanded and more comprehensive use of electronic health records. More on the burden of administrative tasks in healthcare in our April 21 issue, see #5.
Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine
21 Apr, 2017 | 15:18h | UTCElectronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine – Health Affairs (link to abstract – $ for full-text)
Source: By the Numbers: Docs’ Logged-On Time Increases – MedPage Today (free registration required)
Related: Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians (free)
“Electronic health records systems now account for about half of the average doctor’s day”
Use of Medications of Questionable Benefit at the End of Life
20 Apr, 2017 | 14:34h | UTCUse of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia – Journal of the American Geriatrics Society (link to abstract – $ for full-text)
See also: Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia – CBCNews (free) AND Many With Advanced Dementia Receiving Drugs of Uncertain Benefit – Medscape (free registration required)
“Too much use of meds of questionable benefit at the end of life: Just Stop.” (RT @DeeMangin see Tweet)
Mortality Trends After Surgical Safety Checklist
20 Apr, 2017 | 14:31h | UTCMortality Trends After a Voluntary Checklist-based Surgical Safety Collaborative – Annals of Surgery (link to abstract – free PDF available)
Sources: Global Health NOW Newsletter (free) AND South Carolina Hospitals Saw Surgery Deaths Drop After Implementing WHO Checklist – AJMC News (free) AND A simple checklist prevents deaths after surgery, a large new study suggests – The Washington Post (a few articles per month are free)
See also: WHO Surgical Safety Checklist – World Health Organization (free) AND A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population – New England Journal of Medicine (free)
Australasian Society for Infectious Diseases: low value interventions
20 Apr, 2017 | 14:30h | UTCAustralasian Society for Infectious Diseases: low value interventions – The Medical Journal of Australia (free) (RT @ChooseWiselyAU and @ASIDANZ see Tweet)
See also: Choosing Wisely initiative was launched 5 years ago in our April 5 issue.
The society has just released a selection of 5 low value interventions (details in the text):
– Prescribing antibiotics for asymptomatic bacteriuria.
– Taking a swab of a leg ulcer without signs of clinical infection and treating the patient with antibiotics against the identified bacteria.
– Treating upper respiratory tract infections with antibiotics.
– Investigation for fecal pathogens in the absence of diarrhea or other gastrointestinal symptoms.
– Ordering multiple serological investigations for patients with fatigue without a clinical indication or relevant epidemiology.
Value-Based Reforms Linked to Readmission Reductions
18 Apr, 2017 | 14:02h | UTCAssociation Between Hospitals’ Engagement in Value-Based Reforms and Readmission Reduction in the Hospital Readmission Reduction Program – JAMA Internal Medicine (link to abstract – $ for full-text)
Sources: Value-Based Reforms Linked to Readmission Reductions – Medscape (free registration required) AND Richard Lehman’s weekly review(free – see below)
A program of incentives (Medicare Hospital Readmission Reduction Program in the US) was effective in reducing 30 day readmissions following infarction, heart failure, and pneumonia.
The hospital of tomorrow in 10 points
12 Apr, 2017 | 15:54h | UTCThe hospital of tomorrow in 10 points – Critical Care (free)
This is the first article in a new thematic series about the future of critical care (free)
How Many Pills Are Too Many?
12 Apr, 2017 | 15:56h | UTCHow Many Pills Are Too Many? – The New York Times (10 articles per month are free)
“Evidence has mounted about the dangers of taking multiple, perhaps unnecessary, medications” (from Tweet)
F.D.A. Will Allow 23andMe to Sell Genetic Tests for Disease Risk to Consumers
10 Apr, 2017 | 16:03h | UTCF.D.A. Will Allow 23andMe to Sell Genetic Tests for Disease Risk to Consumers – The New York Times (10 articles per month are free)
See also: Before you send your spit to 23andMe, what you need to know – STAT News (free) AND 23andMe given green light to sell DNA tests for 10 diseases – Nature News (free) AND 23andMe Rides Again: FDA Clears Genetic Tests To Predict Disease Risk – Forbes (free) AND Too Much Information? FDA Clears 23AndMe to Sell Home Genetic Tests for Alzheimer’s and Parkinson’s – Scientific American (free)
“The controversial step will significantly expand direct-to-consumer testing – but what if the news is bad?” (from Scientific American above)
How hospitals could be rebuilt, better than before
7 Apr, 2017 | 15:44h | UTCA prescription for the future: How hospitals could be rebuilt, better than before – The Economist (a few articles per monty are free) (RT @EricTopol)
“Technology could revolutionize the way they work”.
Are Virtual Doctor Visits Really Cost-Effective?
7 Apr, 2017 | 15:28h | UTCAre Virtual Doctor Visits Really Cost-Effective? Not So Much, Study Says – Kaiser Health News (free)
“Perhaps telehealth visits don’t save money after all. Increased convenience can increase utilization” (RT @drval)
Nearly a third of tests and treatments are unnecessary
6 Apr, 2017 | 15:22h | UTCNearly a third of tests and treatments are unnecessary – CMAJ News (free) (RT @ChooseWiselyCA)
Press release: Canadians have more than 1 million potentially unnecessary medical tests and treatments every year – Canadian Institute for Health Information (free)
See report: Unnecessary Care in Canada (free PDF)
Growing problem in many countries, making resources less available for treatments and conditions that matter.
Choosing Wisely initiative was launched 5 years ago
5 Apr, 2017 | 21:50h | UTCChoosing Wisely initiative was launched 5 years ago, and now has over 490 recommendations from 18 countries (all resources are free)
Lists from other countries: Choosing Wisely UK / Choosing Wisely Australia / Choosing Wisely Canada
The Choosing Wisely is a leading effort to encourage conversations aimed at reducing unnecessary tests and treatments to improve value in healthcare.
American College of Radiology (ACR) Appropriateness Criteria Adds Topics
4 Apr, 2017 | 21:19h | UTCACR Appropriateness Criteria Adds Topics, Covers More Clinical Variants Than Ever Before (free)
Browse Appropriateness Criteria Topics (free)
Source: Newswise
This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.
To Screen or not to Screen?
4 Apr, 2017 | 21:25h | UTCFree Online Course, Starts April 10. To Screen or not to Screen? Methods and health policies through case studies – University of Geneva and Coursera
Return on investment of public health interventions
3 Apr, 2017 | 19:25h | UTCSource: BMJ News ($)
“For every £1 invested in public health, £14 will subsequently be returned to the wider health and social care economy”. Based on the findings, the authors suggest that cuts to public health services are short sighted and represent a false economy, with substantial opportunity costs.
Impact of total knee replacement practice: cost effectiveness analysis
31 Mar, 2017 | 19:01h | UTCSee also: Knee Replacement Should Be Reserved for More Severe Osteoarthritis, Study Suggests – Physician’s First Watch (free)
Total knee replacement for patients with osteoarthritis had minimal effects on quality of life in this study. Severely affected patients seem to benefit the most from the procedure.
New Lists from Choosing Wisely Canada
31 Mar, 2017 | 19:04h | UTCNew Lists from Choosing Wisely Canada – List of Items Physicians and Patients Should Question (all resources are free)
Critical Care / Pediatric neurosurgery / Sport and exercise medicine / Nursing / Long term care / Medical microbiology
Lists from other countries: Choosing Wisely UK / Choosing Wisely Australia / Choosing Wisely U.S.
The Choosing Wisely initiative aims to reduce unnecessary tests, treatments and procedures to reduce harm and promote value in healthcare.
Putting Patients First by Reducing Administrative Tasks in Health Care
29 Mar, 2017 | 17:13h | UTCSee also: ACP: Stop Saddling Docs With Administrative Tasks – MedPage Today (free registration required)
“It’s time for all those involved in the healthcare industry to reevaluate and reduce the administrative task burden placed on clinicians” (from MedPage commentary above).