Open access

NEWS - Value-Based Care

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)


Lecture: How Less Health Care Can (Sometimes) Be Better For You (free Youtube video)

See also other CLUE Working Group Lecture Series (tweet with lecture links by @KariTikkinen)

“Editor-in-Chief of @JAMAInternalMed, professor Rita Redberg gave the 3rd CLUE Working Group lecture entitled “How Less Health Care Can (Sometimes) Be Better For You” at the Think Corner of the U of Helsinki” (via @KariTikkinen see Tweet)


Case managers improve outcomes for people with dementia and their carers – NIHR Signal (free)

Original Article: The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components – BMC Health Services Research (free)

“The review suggests that nurses may be particularly well placed to act as case managers for people with dementia, perhaps because they have the skills to perform the broad range of tasks associated with the role.” (via @NIHR_DC see Tweet)


Viewpoint: Adding Cost-effectiveness to Define Low-Value Care – JAMA (free)

“The Choosing Wisely initiative focuses on “no-value” health services. Cost-effectiveness analyses that include the incremental value and incremental costs of providing a health service can help us separate “high-value” from “low-value.”” (via @anupam1623 see Tweet)


Newly Revised: Curriculum for Educators and Residents (Version 4.0) – American College of Physicians (free)

News release: ACP introduces updated High Value Care Curriculum for educators and residents – ACP Internist (free)

“The High Value Care Curriculum (HVC) was jointly developed by ACP and the Alliance for Academic Internal Medicine (AAIM) to train physicians to be good stewards of limited health care resources”.


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.


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