Monitoring Medical Devices: Missed Warning Signs Within Existing Data

26Jun
2017

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.

 

Contact Precautions for Endemic MRSA and VRE: Time to Retire Legal Mandates

26Jun
2017

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.

 

Point of view: Generalists key to improved hospital outcomes

26Jun
2017

Fiscal policies for the prevention of diseases

26Jun
2017

Respiratory medicine: Six things physicians and patients should question

26Jun
2017

It’s time to disrupt the existing hospital business model

26Jun
2017

For Some, Pre-Hospice Care Can Be A Good Alternative To Hospitals

26Jun
2017

Tamiflu: an expensive lesson in panic stockpiling

26Jun
2017

Rising Medical Costs Mean More Rough Times Ahead

25Jun
2017

Interesting initiative for improving quality and reducing readmissions from skilled nursing facilities

25Jun
2017

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.

 

What happens when an expensive drug is approved based on a lower bar of proof?

25Jun
2017

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)

 

How app culture is reviving the house call

25Jun
2017

What is people-centered care? And why does it matter?

23Jun
2017

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”.

 

Why We Overrate the Lifesaving Power of Cancer Tests

23Jun
2017

Concierge Medicine For $10 A Month? Yes, It’s Possible

23Jun
2017

Value-Based Care Alone Won’t Reduce Health Spending and Improve Patient Outcomes

22Jun
2017

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

22Jun
2017

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

21Jun
2017

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”

 

Stanford Medicine launches health care trends report

21Jun
2017

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)

 

The Challenge of Polypharmacy

21Jun
2017

Lean: Targeted Therapy for Care Delivery

21Jun
2017

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

20Jun
2017

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”

 

What will healthcare look like in 2030?

20Jun
2017

Simplifying Prenatal Care for Low-Risk Patients

20Jun
2017

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?

20Jun
2017

Why overtreatment and overdiagnosis can be bad for your health

20Jun
2017

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)

 

Why Providers May Fail to Reduce Wait Times

20Jun
2017

How Did Health Care Get to Be Such a Mess?

20Jun
2017

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.

 

Evolocumab for Treatment of High Cholesterol: Clinical Effectiveness

19Jun
2017

Perspectives on the Use of Clinical Pathways in Oncology Care

16Jun
2017

American Society of Health-System Pharmacists – Five Things Physicians and Patients Should Question

16Jun
2017

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)

 

Too much medical care: bad for you, bad for health care systems

16Jun
2017

Hospitals Are Dramatically Overpaying for Their Technology

15Jun
2017

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”.

 

Palliative care: A pathway to value-based care for nursing homes

12Jun
2017

Leading Quality in Changing Times

11Jun
2017

Leading Quality in Changing Times – NEJM Catalyst (free)

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

 

Small wearable devices may lead to big health care savings

8Jun
2017

Can Personalized Care Planning Improve Primary Care?

8Jun
2017

Value-based drug pricing makes sense, but is difficult to pull off

8Jun
2017

WHO updates Essential Medicines List

7Jun
2017

#ASCO2017 – Biosimilar May Be As Effective as Trastuzumab for Early Breast Cancer

7Jun
2017

#ASCO2017 – Small studies get big headlines

7Jun
2017

#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)

 

The Specialists’ Stranglehold on Medicine

7Jun
2017

#ASCO2017 – Survival in a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Cancer Treatment

5Jun
2017

#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)

 

Engaging Patients in Patient Safety – a Canadian Guide

5Jun
2017

The Value of Teaching Patients to Administer Their Own Care

5Jun
2017

Association of a Bundled-Payment Program With Cost and Outcomes in Full-Cycle Breast Cancer Care

4Jun
2017

Cancer drugs are getting better and dearer

1Jun
2017

Diagnosis creep: the new problem in medicine

30May
2017

Direct-to-Consumer Medical Testing in the Era of Value-Based Care

29May
2017

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)

 

Recent articles on payment models published in JAMA

26May
2017

Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery

25May
2017

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.

 

Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery

23May
2017

How to rein in the widening disease definitions that label more healthy people as sick

17May
2017

Switching to biosimilar

16May
2017

Measuring the Burden of Medications in Older Adults near the End of Life

16May
2017

Countering cognitive biases in minimizing low value care

12May
2017

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)

 

8 things that excellent hospital doctors do

5May
2017

Association Between Academic Medical Center Pharmaceutical Detailing Policies and Physician Prescribing

4May
2017

After Knee or Hip Replacement, No Place Like Home

27Apr
2017

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

25Apr
2017

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.

 

Caring for High-Need, High-Cost Patients

24Apr
2017

Why Physician Burnout Is Endemic, and How Health Care Must Respond

24Apr
2017

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.

 

Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine

21Apr
2017

Use of Medications of Questionable Benefit at the End of Life

20Apr
2017

Mortality Trends After Surgical Safety Checklist

20Apr
2017

Australasian Society for Infectious Diseases: low value interventions

20Apr
2017

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.

 

Value-Based Reforms Linked to Readmission Reductions

18Apr
2017

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?

12Apr
2017

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)

 

The hospital of tomorrow in 10 points

12Apr
2017

F.D.A. Will Allow 23andMe to Sell Genetic Tests for Disease Risk to Consumers

10Apr
2017

Are Virtual Doctor Visits Really Cost-Effective?

7Apr
2017

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)

 

How hospitals could be rebuilt, better than before

7Apr
2017

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

6Apr
2017

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

5Apr
2017

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.

 

To Screen or not to Screen?

4Apr
2017

American College of Radiology (ACR) Appropriateness Criteria Adds Topics

4Apr
2017

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

3Apr
2017

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

31Mar
2017

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

31Mar
2017

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

29Mar
2017

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?

29Mar
2017

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, and its importance in healthcare decisions

29Mar
2017

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)

 

Teleretinal Diabetic Retinopathy Screening

28Mar
2017

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%.

 

Healthcare Quality and Safety Online Course

28Mar
2017

Enhanced recovery after surgery

28Mar
2017

Surgeries are being performed with the patient awake

27Mar
2017

Going Under the Knife, With Eyes and Ears Wide Open – New York Times (free access to 10 articles per month)

“More and more surgeries are being performed with the patient awake and looking on, for financial and medical reasons”.

 

Telehealth Doctor Visits

27Mar
2017

Telehealth Doctor Visits May Be Handy, But Aren’t Cheaper Overall – NPR Health News (free)

Link to original article abstract ($ required for full-text): Direct-To-Consumer Telehealth May Increase Access to Care But Does Not Decrease Spending – Health Affairs

Costs have increased in this study because 88 percent of telehealth visits represented people who would not have gone to a doctor otherwise.

 

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