Value-Based Care

N95 Re-Use Instructions

30 Mar, 2020 | 02:06h | UTC

Report: N95 Mask Decontamination

25 Mar, 2020 | 02:18h | UTC

Report: N95 mask can be decontaminated without decreasing filtration efficiency – Stanford Medicine

Stanford: N95 masks can be decontaminated without decreasing filtration efficiency using 70C heat for 30 min. Alcohol and bleach should not be used.” (via @CMichaelGibson see Tweet)


5 Ways Research Could Save the NHS Money

13 Mar, 2020 | 07:57h | UTC

Low back and neck pain tops U.S. health spending – Institute for Health Metrics and Evaluation (free)

Original Study: US Health Care Spending by Payer and Health Condition, 1996-2016 – JAMA (free for a limited period)


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Adapting Lean methods to facilitate stakeholder engagement and co-design in healthcare – The BMJ (free)

See also: Full BMJ Collection on Quality Improvement (free articles)


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Cochrane Sustainable Healthcare: evidence for action on too much medicine – Cochrane Library (free)

News Release: Launch of new Cochrane Sustainable Healthcare Field – Cochrane Library (free)

See Website: Cochrane Sustainable Healthcare (free)


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Early Palliative Care Consultation in the Medical ICU: A Cluster Randomized Crossover Trial – Critical Care Medicine (link to abstract – $ for full-text)

Source: EvidenceAlerts


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Real-Time Benefit Tools for Drug Prices – JAMA (free for a limited period)


Cascades of Care After Incidental Findings in a US National Survey of Physicians – JAMA Network Open (free)

Commentaries: The Important but Rarely Studied Cascade of Care – JAMA Network Open (free) AND Incidental Test Findings and the Burden They Create – MedPage Today (free registration required)

Related: Umbrella Review: Prevalence and Outcomes of Incidental Imaging Findings (free)


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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)


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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)


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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


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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


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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)


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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)


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


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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)


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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)


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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)


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Measuring the Value of Health

4 Feb, 2019 | 22:36h | UTC

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


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


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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)


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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.