Open access

Value-Based Care

Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently – NIHR Signal (free)

Original article: Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (free summary – $ for full-text) AND News Release: Comprehensive geriatric assessment for older adults admitted to hospital (free)

“Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently” (RT @NIHR_DC see Tweet)


Choice of implant combinations in total hip replacement: systematic review and network meta-analysis – The BMJ (free)

Commentary: What is the most effective type of hip implant combination for patients undergoing a hip replacement? – University of Bristol (free)

“…there is no evidence that any of the newer hip implant combinations, such as ceramic or uncemented, are better than the widely used small head metal-on-plastic cemented hip combination, which has been commonly used since the 1960s”.


Debate: the case for and against screening for breast cancer with mammography

The case for mammography: Routine mammograms do save lives: The Science – The Conversation (free)

The case against mammography: Routine mammograms do not save lives: The research is clear – The Conversation (free)

Related: Make Screening Mammography Personal, Say the French – Medscape (free registration required)

“The debate over breast cancer screening continues, with disagreements about the start age, frequency, mortality effect, overdiagnosis, and overtreatment” (from Medscape)


Literature review: the economic costs of lung disease and the cost effectiveness of policy and service interventions – British Lung Foundation and British Thoracic Society (free PDF)

News release: New report identifies the most cost effective NHS activities and programmes to improve lung health – British Thoracic Society (free)

Source: Most cost effective treatments for lung disease identified – The BMJ News ($)

“The most cost effective treatments are: patient education and self management for asthma; stop smoking support for chronic obstructive pulmonary disease (COPD); vaccination programmes for pneumonia; and awareness campaigns for lung cancer” (from The BMJ).


2017 Update on Medical Overuse: A Systematic Review – JAMA Internal Medicine (link to abstract – $ for full-text)

Commentary: Study highlights 10 most unnecessary and overused medical tests and treatments – University of Maryland School of Medicine, via EurekAlert (free)


Outcomes In Two Massachusetts Hospital Systems Give Reason For Optimism About Communication-And-Resolution Programs – Health Affairs (link to abstract – $ for full-text)

Commentaries: After medical error, apology goes a long way – Stanford University Medical Center, via ScienceDaily (free) AND Conflict Resolution Program: ‘Cause for Optimism’ – MedPage Today (free registration required)


Potential Implications of NORSTENT (Norwegian Coronary Stent Trial) in Contemporary Practice – Circulation (free)

Original article: Drug-Eluting or Bare-Metal Stents for Coronary Artery Disease – New England Journal of Medicine (free)

In this large trial, differences in outcomes between bare metal stents (BMS) and drug eluding stents (DES) were small. During 6 years of follow-up there was a 3.3% absolute risk reduction in any repeat revascularization with DES, without differences in cardiovascular mortality or death.


When surgery is just a stitch-up – The Guardian (RT @Onisillos  see Tweet)

Related article: Use of placebo controls in the evaluation of surgery: systematic review – The BMJ (free)

“With evidence mounting that many minor operations owe their success to the placebo effect, is it time to call a halt to some routine procedures?”


Self-management interventions including action plans for patients with Chronic Obstructive Pulmonary Disease (COPD) – Cochrane Library (free)

Full review: Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease (link to summary – $ for full-text)

Related: Asthma self-management programmes can reduce unscheduled care – NIHR Signal (free)

Self-management interventions that include a COPD exacerbation action plan are associated with improvements in health-related quality of life and lower probability of respiratory-related hospital admissions.


What do hypnotics cost hospitals and healthcare? – F1000 Research (free)

Source: Hospital Medicine Virtual Journal Club

“A best estimate is that U.S. costs of hypnotic harms to healthcare systems are on the order of $55 billion, but conceivably might be as low as $10 billion or as high as $100 billion”.


A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission – BMJ Open (free) (RT @NIHR_DC)

Alternatives to hospital admission for people aged over 65 years can be safe and reduce costs across a range of acute and chronic conditions.


Last Month in Oncology with Dr. Bishal Gyawali: July 2017 – ecancer News (free)

A critical review of the latest “breakthrough” articles in oncology.


Choosing Wisely: An International Campaign to Combat Overuse, with new Top 10 recommendations (free) (RT @ChooseWiselyCA and @CADTH_ACMTS see Tweet with infographic)

See more on the Choosing Wisely initiative in our April 5 issue (see #6)

Choosing Wisely has prioritized 10 recommendations for limiting overuse internationally.


American College of Surgeons (ACS) 2017 Quality and Patient Safety Conference: Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost – ACS, via EurekAlert (free)

Related guideline: Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free)

See other Enhanced Recovery After Surgery (ERAS) Guidelines and Reviews in our collection and in the ERAS Society Website.

“Successful protocol shortens hospital stays, reduces patients’ risk of complications, and cuts costs up to $11,000 per procedure”


2017 ACS Quality and Safety Conference: “Strong for Surgery” Shows Promise in Reducing Smoking Rates for Patients Facing Surgery – American College of Surgeons, via NewsWise (free)

“Study suggests big drop in smoking rates when surgeons help patients quit before their operations”.


What carcinoembryonic antigen level should trigger further investigation during colorectal cancer follow-up? A systematic review and secondary analysis of a randomised controlled trial – Health Technology Assessment (free)

Source: ACP Journal Wise ($)

“The results suggest that (1) CEA testing should not be used alone as a triage test; (2) in year 1, testing frequency should be increased (to monthly for 3 months and then every 2 months); (3) the threshold for investigating a single test result should be raised to 10 µg/l; (4) after the second CEA test, decisions to investigate further should be made on the basis of the trend in CEA levels; (5) the optimal threshold for investigating the CEA trend falls over time; and (6) continuing smokers should not be monitored with CEA testing”.


Implant Survival After Minimally Invasive Anterior or Anterolateral Vs. Conventional Posterior or Direct Lateral Approach: An Analysis of 21,860 Total Hip Arthroplasties from the Norwegian Arthroplasty Register (2008 to 2013) – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)

Commentary: Implant survival for minimally invasive vs. open hip surgery: 4 key notes – Spine Review (free)

Source: EvidenceAlerts (free resource to find articles of interest in all specialties)

“There were no significant differences among the surgical approaches with regard to the 2 and 5-year survival rates or RR of revision due to any cause”


Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis – Health Technology Assessment (free)

Source: ACP Journal Wise ($)

“A national screening programme for atrial fibrillation is likely to represent a cost-effective use of resources, with systematic opportunistic screening more likely to be cost-effective than systematic population screening”


Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-Analysis – Chest (free)

Source: Video Laryngoscopy Does Not Improve First-Pass Success in ICU Patients – Journal Watch ($)

“The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients”.


Effectiveness of Pharmacist Intervention to Reduce Medication Errors and Health-Care Resources Utilization After Transitions of Care: A Meta-analysis of Randomized Controlled Trials – Journal of Patient Safety (link to abstract – $ for full-text)

Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)

Pharmacist transition of care intervention seems to be an effective strategy to reduce medication errors after hospital discharge and to reduce subsequent emergency room visits.


Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery – British Journal of Surgery (link to abstract – $ for full-text)

Source: ACP Journal Club ($ resource to find articles of interest)

In this RCT, a comprehensive preoperative geriatric assessment and optimization before vascular surgery was associated with shorter length of hospital stay, lower incidence of complications, and patients were less likely to be discharged to a higher level of dependency.


Editorial: WHO downgrades status of oseltamivir – The BMJ (free)

@WHO downgrades status of oseltamivir. BMJ editorial discusses important lessons from the Tamiflu story” (RT @bmj_latest  see Tweet)


Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis – JAMA (link to abstract – $ for full-text)

Commentaries: More Doubt Cast on CPAP for Reducing CVD Risk in Sleep Apnea Patients – MedPage Today (free registration required) AND Positive airway pressure doesn’t reduce heart risk with sleep apnea – Reuters (free)

“PAP for obstructive sleep apnea improves quality of life but not CV events or BP with up to 5 years of follow up” (RT @AnilMakam see Tweet)


Health Plans That Nudge Patients to Do the Right Thing – New York Times (10 articles per month are free)

“What if health insurance was more generous in paying for things that actually work?” (RT @NYTHealth see Tweet)


Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health (free PDF)

See also: News release (free) AND Executive summary (free PDF) AND Key Points (free PDF) AND Characteristics of Successful Care Models for High-Need Patients (free PDF)

Commentary: New NAM publication examines improving outcomes, reducing costs for ‘high-needs patients’ – National – National Academies of Sciences, Engineering, and Medicine, via EurekAlert (free)

See more resources on high-need, high-cost patients in our July 4th issue (see #2)

Source: STAT News Newsletter

“Nearly half of the nation’s spending on health care is driven by 5 percent of patients, and improving health outcomes and curbing spending in health care will require identifying who these high-needs patients are and providing coordinated services” (from EurekAlert)


Longitudinal Patterns of Medication Nonadherence and Associated Health Care Costs – Inflammatory Bowel Diseases (link to abstract – $ for full-text)

Commentary: Taking medications as prescribed important to control health care costs – Cincinnati Children’s Hospital Medical Center, via EurekAlert (free)

In this small study, patients with increasing nonadherence over time demonstrate more than a 3-fold increase in costs compared with adherent patients.


Viewpoint: The Smart-Medicine Solution to the Health-Care Crisis – The Wall Street Journal (by @EricTopol) (a few articles per month are free)

“Our health-care system won’t be fixed by insurance reform. To contain costs and improve results, we need to move aggressively to adopt the tools of information-age medicine”.


Hospitalists’ Winning Abstracts Target High-Value Care – Medscape (free registration required)

““High-value” care was a hot topic at this year’s #HM17” (RT @Medscape see Tweet)


Waiting and watching with ‘Stage 0’ breast cancer put to nationwide test – The Washington Post (a few articles per month are free)

“Treatment of early-stage breast cancer: is no treatment an option?” (RT @GemmaJacklyn see Tweet)


Precision Medicine: the Promise vs. the Reality – Michigan University Health Lab (free) (RT @pash22 see Tweet)

“Scientists find great potential in using genetic sequencing to help direct targeted cancer therapy, but practicing oncologists see some important limitations”.


Free Online Course: Measuring and Valuing Health – The University of Sheffield and FutureLearn (RT @Imperial_GHD see Tweet)

“Learn how Patient Reported Outcome Measures and Quality Adjusted Life Years can compare treatments and inform healthcare spending”.


A Reality Check for IBM’s AI Ambitions – MIT Technology Review (free) (RT @EricTopol see Tweet)

“IBM overhyped its Watson machine-learning system, but the company still could have the best access to the kind of data needed to make medicine much smarter”.


Viewpoint: Monitoring Medical Devices: Missed Warning Signs Within Existing Data – JAMA (free)

Related: The lap band for weight loss is a tale of medicine gone wrong – VOX (free) Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery – JAMA Surgery (link to abstract – $ for full-text) AND Safety, Effectiveness of Gastric Banding Called Into Question – Medscape (free registration required) AND 1 In 5 Gastric Band Surgeries Require Corrective Operations – American Council on Science and Health (free)

The authors use the example of gastric band surgery to discuss how available data may be used more appropriately for earlier detection of problems in the safety of medical devices.


Viewpoint: Contact Precautions for Endemic MRSA and VRE: Time to Retire Legal Mandates – JAMA (free)

“Contact precautions are easy to use w a single patient, but burdensome when applied to an entire hospital” (RT @JAMA_current see Tweet)

This viewpoint suggests a more selective use of contact precautions for the control of endemic pathogens.


Necessity is the mother of invention: an innovative hospitalist-resident initiative for improving quality and reducing readmissions from skilled nursing facilities – Journal of Community Hospital Internal Medicine Perspectives (free) (RT @HMVJC see Tweet)

In this model of care, a hospitalist-led team, including the resident on the geriatrics rotation, followed patients discharged from the hospital to the skilled nursing facility, leading to significant decrease in readmission rates.


Insurers Battle Families Over Costly Drug for Fatal Disease – The New York Times (10 articles per month are free)

“A new drug can cost over a million dollars, even though it’s unclear if it works. Now, insurers are refusing to pay” (RT @NYTHealth see Tweet)


WHO Framework on integrated people-centered health services (free resources)

Video: WHO – What is people-centered care? And why does it matter? Our new video explains! (free) (RT @WHO see Tweet)

“Integrated people-centered health services means putting the comprehensive needs of people and communities, not only diseases, at the center of health systems, and empowering people to have a more active role in their own health”.


Value-Based Care Alone Won’t Reduce Health Spending and Improve Patient Outcomes – Harvard Business Review (a few articles per month are free) (RT @pash22 see Tweet)

“We believe that value-based care, implemented using lean principles and in conjunction with an ongoing, community-wide effort to address social determinants of health, can reduce health spending and deliver on the promise of better health”


Performance Improvement: Phenytoin Toxicity – JAMA (free)

Interesting case of medication error and prevention of subsequent adverse events (RT @JAMA_current see Tweet)


Obstetrics and Gynaecology: Ten Things Physicians and Patients Should Question – Choosing Wisely (free) (RT @ChooseWiselyCA see Tweet)

“New Choosing Wisely recommendations list! @SOGCorg identifies 10 tests, treatments to question in obstetrics and gynecology”


Harnessing the Power of Data in Health – Stanford Medicine 2017 Health Trends Report (free PDF)

News release: Stanford Medicine launches health care trends report (free)

“Stanford Medicine launches report on health care trends” (RT @StanfordMed see Tweet)


Lean: Targeted Therapy for Care Delivery –  Journal of the National Comprehensive Cancer Network (free)

The possible benefits of applying the “Lean” approach to oncology care delivery.


Overuse of Chest CT in Patients With Stage I and II Breast Cancer: An Opportunity to Increase Guidelines Compliance at an NCCN Member Institution – Journal of the National Comprehensive Cancer Network (free)

News release: NCCN Guidelines Compliance for Chest CT Reduces False Positives and Decreases Health Care Spending in Breast Cancer, Study Finds (free)

In this cohort 11% of patients with stage I and 36% of patients with stage II breast cancer underwent chest CT, despite NCCN Guidelines against the exam. “Nearly one-third of these patients were found to have pulmonary nodules, but only 1.3% were ever diagnosed with pulmonary metastases”


How Mayo Clinic Is Simplifying Prenatal Care for Low-Risk Patients – Harvard Business Review (a few articles per month are free)

“Prenatal care model makes mothers-to-be active participants while reducing costs & time commitment” (RT @MayoClinic see Tweet)


Changes in Hospital Quality Associated with Hospital Value-Based Purchasing – New England Journal of Medicine (link to abstract – $ for full-text)

Commentaries: Value-Based Purchasing Program Has Little Effect – Medscape (free registration required) AND Is There Value in Hospital Value-Based Purchasing? – NEJM Catalyst (free)

How VBP works: Hospital Value-Based Purchasing – U.S. Centers for Medicare & Medicaid Services (free)


Why overtreatment and overdiagnosis can be bad for your health – CBC Radio (free text and audio)

See more on the Choosing Wisely initiative in our April 5 issue, see #6.

“Choosing Wisely on CBC Sunday about overdiagnosis & importance of speaking with your doc about tests/treatments” (RT @ChooseWiselyCA see Tweet)


Opinion: How Did Health Care Get to Be Such a Mess? – The New York Times (10 articles per month are free)

Opinion over payment models in the U.S health care system.


New Choosing Wisely List: American Society of Health-System Pharmacists – Five Things Physicians and Patients Should Question (free)

See more on the Choosing Wisely initiative in our April 5 issue, see #6.

“Great choosing wisely list from @ASHPOfficial. Great doctoring tips for physicians & trainees” (RT @AnilMakam see Tweet)


Hospitals Are Dramatically Overpaying for Their Technology – Harvard Business Review (a few articles per month are free)

“For years, hospitals have invested in sophisticated devices and IT systems that, on their own, can be awe-inspiring. Yet these technologies rarely share data, let alone leverage it to support better clinical care”.


Leading Quality in Changing Times – NEJM Catalyst (free)

“4 principles for quality leaders in brave new world of population health” (RT @nejmcatalyst see Tweet)


#ASCO2017 – Small studies get big headlines at ASCO 2017 – HealthNewsReview (free)

“Claim – Biggest breakthrough in a decade”. “Reality – The trial included only 15 women; no survival outcomes measured” (RT @HealthNewsRevu see Tweet)


#ASCO2017 – Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment – JAMA (free)

Commentaries: Quickly reporting cancer complications may boost survival – STAT News (free) AND If This Were a Drug, the Price Would Be $100,000 – Medscape (free registration required) AND How a simple tech tool can help cancer patients live longer – The Washington Post (free)

“For surveillance of cancer, digital tracking of patient-generated data improves survival”. “The cost of digital tracking is very low and > 5 months median survival improvement is more than cancer drugs that cost > $100,000” (RT @EricTopol see Tweets and Answers)


Viewpoint: Direct-to-Consumer Medical Testing in the Era of Value-Based Care – JAMA (free)

See also a recent discussion on direct-to-consumer genetic testing in our April 10th issue, see #5

Others disagree: “Dissing every consumer medical test as “low value”. Sorry, that’s not true. It’s called paternalism” (RT @EricTopol see Tweet)


Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial – JAMA Surgery (free) (RT @PreetiNMalani see Tweet)

Commentary: Anti-delirium strategy reduces after-surgery confusion in elderly – Reuters Health (free)

Multicomponent nonpharmacologic interventions, including orienting communications, oral and nutritional assistance, and early mobilization reduced postoperative delirium by 56% and length of stay by 2 days.


Review: 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)


After 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: 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.


Survey 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.


Electronic 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”


Australasian 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.


Association 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.


How 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)


Are 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)


A 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”.


Nearly 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, 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.


ACR 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.


Return on investment of public health interventions: a systematic review – Journal of Epidemiology and Public Health (free)

Source: 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.


New 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.


Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative – The BMJ (free)

See 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.


Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians (free)

See 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).


Value-Based Purchasing: Time for Reboot or Time to Move On? by Ashish K. Jha, MD – The JAMA Forum (free)

Pay-for-performance (P4P) as a policy tool does not seem to be improving health care quality or lowering costs.


Regression to the mean, or why perfection rarely lasts – The Conversation (free) (RT @PaulGlasziou)

“Regression to the mean, and its importance in healthcare decisions” (RT @Tammy_Hoffmann see Tweet)


Implementation and Evaluation of a Large-Scale Teleretinal Diabetic Retinopathy Screening Program in the Los Angeles County Department of Health Services – JAMA Internal Medicine (free) (RT @PreetiNMalani)

Editorial: Seeing the Effect of Health Care Delivery Innovation in the Safety Net (free)

A large-scale telemedicine diabetic retinopathy screening program increased overall rates of screening by 16.3%, and wait times for screening were reduced by 89.2%.


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