Open access

NEWS - Value-Based Care

Are Hospitals Becoming Obsolete? – The New York Times (10 articles per month are free)


Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: A systematic review and meta-analysis – PLOS One (free)

“Despite higher operative cost, robot-assisted laparoscopic surgery does not result in statistically better treatment outcomes, with the exception of lower estimated blood loss. Operative time and total complication rate are significantly more favorable with conventional laparoscopic surgery”.


Medical News & Perspectives: How Value-Based Medicare Payments Exacerbate Health Care Disparities – JAMA (free for a limited period)


Consistently High Turnover in the Group of Top Health Care Spenders – NEJM Catalyst (free)

“Within a given year, most health spending is done by a small group of individuals. However, most of those people are new each year” (via @nejmcatalyst see Tweet)


A revolution in health care is coming – The Economist (a few articles per month are free) (via @equitylist)

“Welcome to Doctor You”


Weekend Surgical Care and Postoperative Mortality: A Systematic Review and Meta-Analysis of Cohort Studies (free)

Commentary: Evidence Supports ‘Weekend Effect’ for Mortality after Surgery – Wolters Kluwer, via NewsWise (free)

“The odds of postoperative mortality were 27 percent higher for patients admitted to the hospital on Saturday or Sunday, compared to those hospitalized on a weekday” (from NewsWise).


Supporting Patients Through Serious Illness and the End of Life: Sutter Health’s AIM Model – The Commonwealth Fund (free)

“By proactively managing care for the terminally ill, the Advanced Illness Management program has produced savings of $8,000–$9,000 per patient” (via @commonwealthfnd see Tweet)


Why American doctors keep doing expensive procedures that don’t work – VOX (free)

“The proportion of medical procedures unsupported by evidence may be nearly half”.


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: 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.


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.


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