Value-Based Care

Disappointment in the Value-Based Era: Time for a Fresh Approach? – JAMA (free for a limited period)

Related: Designing a High-Performing Health Care System for Patients with Complex Needs: Ten Recommendations for Policymakers – The Commonwealth fund (free) AND Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health – National Academy of Medicine (free PDF) AND Focusing on High-Cost Patients — The Key to Addressing High Costs? – NEJM Catalyst (free) AND  Systematic review of high-cost patients’ characteristics and healthcare utilization – BMJ Open (free) AND Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis – Canadian Medical Association Journal (free) AND Multimorbidity: a priority for global health research – The Academy of Medical Sciences (free) AND The global burden of multiple chronic conditions: A narrative review – Preventive Medicine Reports (free) AND Redesigning Care for High-Cost, High-Risk Patients – Harvard Business Review (a few articles per month are free) AND Multimorbidity: clinical assessment and management – NICE Guideline (free) AND Multimorbidity in Older Adults with Cardiovascular Disease – American College of Cardiology, Latest in Cardiology (free) AND  Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs (free) AND Playbook: Better Care for People with Complex Needs – Institute for Healthcare Improvement (free)


Prevalence and Predictability of Low-Yield Inpatient Laboratory Diagnostic Tests – JAMA Network Open (free)

Commentary: Is that blood test really necessary? AI could help decide – Stanford Medicine (free)


Related Commentary on Twitter


2019 Update on Medical Overuse

10 Sep, 2019 | 01:50h | UTC

#165 Things We Do For No Reason™ Part 2 – The Curbsiders Internal Medicine Podcast (free audio and summary)

See also: Part 1: #109: Things We Do For No Reason: A High Value Episode – The Curbsiders internal Medicine Podcast (free audio and summary)

Related Series: Choosing Wisely: Things We Do For No Reason – Journal of Hospital Medicine (free articles)

“Discover common practices that persist in the hospital wards despite no proven benefit!”


Too Much Medicine: Not Enough trust?

11 Aug, 2019 | 22:18h | UTC

Too Much Medicine: Not Enough trust? – Journal of Medical Ethics (free)


Related Commentary on Twitter


Potential Medicare Savings From Generic Substitution and Therapeutic Interchange of ACE Inhibitors and Angiotensin-II-Receptor Blockers – JAMA Internal Medicine (free for a limited period)

“By maximizing generic substitution and therapeutic interchange, Medicare could have saved approximately $676 million (89.6%) in 2016 and 2017 of the total $754 million spent on these brand-name ACEIs and ARBs during those 2 years”.


Choosing Wisely India: ten low-value or harmful practices that should be avoided in cancer care – The Lancet Oncology (free registration required)

Commentary: 10 Ways to Improve the Value of Cancer Care – Medscape (free registration required)

See other lists of low-value practices in oncology:

– American Society of Clinical Oncology

– Society of Surgical Oncology

– Society of Gynecologic Oncology

– American Society for Radiation Oncology

– Medical Oncology Group of Australia

– Oncology – Choosing Wisely Canada

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


Related Commentary on Twitter


Viewpoint: Redefining the Physician’s Role in Cost-Conscious Care: The Potential Role of the Electronic Health Record – JAMA (free for a limited period)

“Displaying price information in EHRs could mark the next step in the transformation of the practice of medicine… The next generation of EHRs should include prices for the majority of medical products and services: medications, laboratory testing, surgical procedures, and physician visits.”


Choosing Wisely: Case Studies from the Top 10 Recommendations Across Campaigns – The Commonwealth Fund (free case studies)

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


Related Commentary on Twitter

Opinion: The Business of Health Care Depends on Exploiting Doctors and Nurses – The New York Times (10 articles per month are free)

“One resource seems infinite and free: the professionalism of caregivers.”


Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries – JAMA Internal Medicine (free for a limited period)

Commentary: Cascades Of Care – American Council on Science and Health (free)

Related: Evaluation of an Intervention to Reduce Low-Value Preoperative Care for Patients Undergoing Cataract Surgery (link to abstract and commentary) AND Systematic Review: Routine Preoperative Medical Testing for Cataract Surgery (free)


Related Commentary on Twitter (thread – click for more)


Choosing Wisely Canada-Top Five List in Hepatology: Official Position Statement of the Canadian Association for the Study of the Liver (CASL) and Choosing Wisely Canada (CWC) – Annals of Hepatology (free)

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

1 – Don’t order serum ammonia to diagnose or manage hepatic encephalopathy (HE).

2 – Don’t routinely transfuse fresh frozen plasma, platelets or give Vitamin K to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ligation, or any other minor invasive procedures.

3 – Don’t order HFE genotyping based on serum ferritin values alone to diagnose hereditary hemochromatosis.

4 – Don’t perform computed tomography (CT) or magnetic resonance imaging (MRI) routinely to monitor benign focal liver lesions (ex. focal nodal hyperplasia, hemangioma).

5 – Don’t repeat hepatitis C viral load testing in an individual who has established chronic infection, outside of antiviral treatment.

(Under a Creative Commons license)


The Development of Pathways in Palliative Medicine: Definition, Models, Cost and Quality Impact – Healthcare (free) (via @Abraham_RMI)


Related Commentary on Twitter


How organisations contribute to improving the quality of healthcare – The BMJ (free)


Related Commentary on Twitter


Why you should be a “medical conservative” – Lown Institute (free)

Original Article: Perspective: The Case for Being a Medical Conservative (free article and twitter thread)

“being a medical conservative means being skeptical about new medical advances until unbiased and high-quality evidence shows a clear benefit”


Survey Snapshot: Is Transparency the Answer? – NEJM Catalyst (free)


Related Commentary on Twitter

Bundled Payments Are Moving Upstream – NEJM Catalyst (free)

“For bundled payments to fulfill their promise of delivering greater value to patients, bundling must shift toward the condition or person level rather than the procedure level”


2018 Update on Pediatric Medical Overuse

27 Feb, 2019 | 00:43h | UTC

2018 Update on Pediatric Medical Overuse: A Review – JAMA Pediatrics (free for a limited period)


Related Commentary on Twitter (Thread)


Five Warning Signs of Overdiagnosis

11 Feb, 2019 | 00:05h | UTC

Viewpoint: Potential Excessive Testing at Scale: Biomarkers, Genomics, and Machine Learning – JAMA (free for a limited period)


Related Commentary on Twitter


Measuring the Value of Health

4 Feb, 2019 | 22:36h | UTC

Measuring the value of health – Bill & Melinda Gates Foundation (free)


Related Commentary on Twitter


Solutions for non-communicable disease prevention and control – The BMJ (free articles)


Related Commentary on Twitter


Doing things for no reason in the hospital – The BMJ Opinion (free)

“Many of the things we do as doctors continue simply because “that’s the way we’ve always done it,” says Abraar Karan”


Association Between Reimbursement Incentives and Physician Practice in Oncology: A Systematic Review (link to abstract – $ for full-text)


Related Commentary on Twitter


Too Much Medicine: Not Enough Trust?

7 Jan, 2019 | 11:55h | UTC

Top 8 Healthcare Predictions for 2019

16 Nov, 2018 | 02:19h | UTC

Perspective: Getting Rid of Stupid Stuff

16 Nov, 2018 | 01:40h | UTC

Order Wisely®: Appropriate use of tests & treatments – High Value Practice Academic Alliance (free) (via @KariTikkinen)

Comprehensive educational program that reviews appropriate use of imaging exams, lab tests, medications, transfusions and procedures to promote high-value practice.


Nine ways research could save the NHS money – NHS Dissemination Centre (free)

New infographic series with selected NIHR Signals covering a range of treatments and initiatives that are cost effective.


Perspective: What the Tests Don’t Show

11 Oct, 2018 | 20:11h | UTC

What the tests don’t show – The Washington Post (a few articles per month are free)

“Many doctors are surprisingly bad at reading test results and/or fail to grasp how false positives work. This is putting patients at risk” (via @pash22 see Tweet)


Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes – JAMA Network Open (free)

“Same day discharge after elective PCI used infrequently (3.5%), while safe + associated w/ reduced costs” (via @krychtiukmd see Tweet)


Podcast: High Value Care

27 Sep, 2018 | 22:23h | UTC

Guideline for the management of hip and knee osteoarthritis – Royal Australian College of General Practitioners (free PDF)

News Release: Updated osteoarthritis guideline designed to reduce unnecessary imaging and surgery (free)

Commentary: Australia hopes to reduce unnecessary imaging, surgery with updated osteoarthritis guidelines – Health Imaging (free)

““The Guideline for the management of knee and hip osteoarthritis,” offer up exercise and weight loss as a first line defense, and warn against costly treatments using glucosamine, opioids and arthroscopic surgery, said David Hunter, co-chair of the RACGP group responsible for the update.” (from Health Imaging)


The Community Health Worker Boom – NEJM Catalyst (free)

“The key question is not whether community health workers are effective, but how we can make them as effective as possible.”


Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost – NEJM Catalyst (free)

“Another solution might be to capitalize on patients’ vested interest in their own health care by actively engaging them in the entry of their own medical history information into the EHR.”


Podcast: Things We Do For No Reason

23 Aug, 2018 | 23:44h | UTC

Review: Overdiagnosis in Primary Care

17 Aug, 2018 | 02:10h | UTC

A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests – The New York Times (10 articles per month are free)

“Doctors are known for complaining about how the malpractice system adds costs. But it has been hard to prove, until now.”


Management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach – The Lancet (free)

Commentaries: Patient-centred care for multimorbidity: an end in itself? – The Lancet (free) AND Results of the largest ever multimorbidity trial in primary care challenge current thinking -NIHR News (free)

Related: Designing a High-Performing Health Care System for Patients with Complex Needs: Ten Recommendations for Policymakers (series of free articles on the topic) AND Multimorbidity: A Priority for Global Health Research (free report and commentaries)

“In the largest ever trial of an intervention to treat people with multiple long-term conditions (multimorbidity) in primary care, NIHR-researchers found that the patient-centred approach taken improved patients’ experience of their care but did not improve their health-related quality of life. This is a challenge to current thinking on which UK and international guidelines are based”. (from NIHR News)


Helping patients choose wisely – The BMJ (free)

Related: The Choosing Wisely initiative was launched 5 years ago, and now has over 490 recommendations from 18 countries (free)

See complete lists from: Choosing Wisely U.S., Choosing Wisely UKChoosing Wisely Australia AND Choosing Wisely Canada

“One of the main barriers to tackling the problem of overuse is that doctors are concerned patients will find it difficult to accept fewer interventions. However, informed patients often opt for less intervention, not more.” (via @bmj_latest see Tweet)


QALYs in 2018—Advantages and Concerns – JAMA (free for a limited period)


Trying to Put a Value on the Doctor-Patient Relationship – The New York Times (10 articles per month are free)

“In its push for profits, the U.S. health care system has made it difficult for patients to get personal attention from doctors. But what if hands-on medicine actually saves money — and lives?”


ASCO 2018: Shortening Adjuvant Trastuzumab to 6 Months in Patients With HER2-Positive Early Breast Cancer Is Effective and Reduces Cardiac Toxicities – The ASCO Post (free)

Commentaries: Test of Herceptin Finds Briefer Treatment Can Work, With Fewer Side Effects – NPR (free) AND Shorter drug treatment OK for many breast cancer patients – Associated Press (free) AND For Women With Early Breast Cancer, Herceptin Treatment Can Be Much Shorter – The New York Times (10 articles per month are free)

““For women with early-stage breast cancer who needed the drug Herceptin, 6 months of treatment were as good as 12, a major study found. Less risk of side effects, less cost, less time “being a patient.”” (via @NYTHealth see Tweet)