April 2020 Learning Network Resources

Blogs, Issue Briefs, Opinion Pieces and More…

  • “What worries you most?’ Survey examines patients’ biggest health care worries.” Lown Institute. February 2020
    “Fewer patients–but still a significant amount–expressed worries about health care quality: being overtreated, misdiagnosed, or getting an infection while in the hospital. Between 25-30% of patients were ‘very worried’ about these quality issues. Another theme of health care concerns was trust and communication; about 30% of respondents were ‘very worried’ about finding a doctor they could trust, or that they would not be given the information they need to make an informed decision. This survey shows that cost, quality, trust, and communication are key areas for health system reform.”

  • Lidner R, Levinson W, Wolfson D. Choosing Wisely: Clinicians as Agents for Change. Improving Use of Medicines and Medical Tests in Primary Care. February 2020
    “Choosing Wisely differentiates itself from previous campaigns that have sought to influence medical culture by actively engaging health care professionals as leaders in change, avoiding top-down drive approaches, as well as encouraging locally driven and contextualised clinical improvements. This chapter explores the origins of Choosing Wisely, its implementation and effectiveness around the world. It identifies the criteria for success and outlines how local champions are nurtured and sustained.”

  • How to reduce medication overload in long-term care. McKnight’s Long Term Care News. February 2020
    “Medication overload is especially prevalent in nursing homes, because residents tend to be older and frailer, with multiple chronic conditions. While 42% of Americans over 65 are taking five or more prescription medications, more than 90% of long-term care residents take more than five medications and 65% take more than 10. As a result, nursing home residents are at a very high risk of experiencing a serious drug side effect. An estimated 2 million ADEs occur each year in nursing homes, and 1 in 7 residents are hospitalized each year as a result of an adverse drug event.”

  • 12 emergency departments make ‘honor roll’ for reducing avoidable imaging spending by millions. Radiology Business. February 2020
    “The American College of Emergency Physicians is recognizing a dozen emergency departments across the U.S. for their work to reduce unnecessary imaging and improve care for patients. Those involved are participants in the doc group’s Emergency Quality Network Honor Roll, which includes a year-long collaborative during which physicians share their imaging data and discuss best practices virtually. Since ACEP launched the effort, participating EDs have saved some $55 million from avoiding unnecessary imaging and hospitalizations. Their efforts have also led to 30,000 fewer patients being harmed by ionizing radiation according to an announcement.”

Journals

  • Ruka M, Moore H, O’Keeffe D. Inherited Thrombophilia Testing in a Large Tertiary Hospital in New Zealand: Implementation of a Choosing Wisely Protocol to Reduce Unnecessary Testing and Costs. New Zealand Medical Journal. April 2020
    “The majority of inherited thrombophilia tests performed in our laboratory did not comply with BSH guidelines. A multimodal inherited thrombophilia Choosing Wisely programme was successful in reducing unnecessary testing. A laboratory protocol that required screening of every inherited thrombophilia request by a haematologist was necessary for the success of this programme.”

  • Bejjanki HH, Mramba LK, Beal SG, Radhakrishnan N, Bishnoi R, Shah C, Agrawal N, Harris N, Leverence R, Rand K. The role of a best practice alert in the electronic medical record in reducing repetitive lab tests. Dovepress. March 2020
    “The present study included all hospital inpatients and covered 17 clinical laboratory tests. This rather simple and low-cost intervention resulted in significant reductions in percentage duplicates of several tests and resulted in cost savings. The study also highlights the role of hospitalists in quality improvement.”

  • Curtis JR, Kross EK, Stapleton RD. The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19). JAMA Network. March 2020
    “The COVID-19 pandemic is placing tremendous stress on health care systems. There are many important components of an appropriate response to this pandemic, including public health measures to reduce rapidity and extent of spread. Another important element of the best possible response is to ensure that clinicians have high-quality discussions both about advance care planning for individuals in the community, especially those of older age and with chronic illness, and about goals of care with patients or their families when patients have illness that requires hospitalization.”

  • Smith ME, Vitous CA, Hughes TM, Shubeck SP, Jagsi R, Dossett LA. Barriers and Facilitators to De-Implementation of the Choosing Wisely® Guidelines for Low-Value Breast Cancer Surgery. Breast Oncology. March 2020
    “To address overuse of unnecessary practices, several surgical organizations have participated in the Choosing Wisely® campaign and identified four breast cancer surgical procedures as unnecessary. Despite evidence demonstrating no survival benefit for all four, evidence suggests only two have been substantially de-implemented. Our objective was to understand why surgeons stop performing certain unnecessary cancer operations but not others and how best to de-implement entrenched and emerging unnecessary procedures.”

  • Panagiotou A, Sharma K. Choosing Wisely in Post-Acute and Long-Term Care: Evaluating internal medicine residents knowledge gaps. The Journal of Post-Acute and Long-Term Care Medicine. March 2020
    “The results illustrate that since the implementation of Choosing Wisely campaign, there has been an improvement in IM residents’ overall knowledge pertaining to the recommendations in the post-acute and long-term care arena. However, there is a consistent knowledge gap in their understanding of the benefits of careful hand feeding over PEG insertion and feeding in advanced dementia. IM residents are increasingly comfortable in advising against PEG insertion in patients with advanced dementia, but lack of understanding of the benefits of careful hand feeding may be limiting them to recommend this as an evidence-based approach to feeding these patients.”

  • Bartlett KJ, Vo AP, Rueckert J, Wojewoda C, Steckel EH, Stinnett-Donnelly J , Repp AB.  Promoting appropriate utilisation of laboratory tests for inflammation at an academic medical centre. BMJ Open Quality. February 2020
    Promoting appropriate utilisation of laboratory tests for inflammation at an academic medical centre.
    “A simple, reproducible, multifaceted initiative was associated with sustained reductions in ESR tests and modest decreases in institutional costs. However, inappropriate ESR test ordering persisted following the intervention, suggesting opportunities for continued improvement and the possible need for more active CDS.”

Media Coverage

  • How to help your child avoid unnecessary medical care. The Week. March 2020
    “Researchers listed and analyzed how frequently doctors prescribed 20 low-value pediatric services, including imaging procedures for sinus infections, and oral antibiotics for colds. They discovered that one in nine publicly insured and one in 11 privately insured children received such unneeded health-care services in 2014.”

  • 2020 Leaders in Health Care Awards: Washington Health Alliance Community Checkup Award. Seattle Business. March 2020
    “Awards normally go to the most or biggest. This award, however, from Seattle Business magazine and the Washington Health Alliance, takes a different approach, recognizing the smallest as the most outstanding performers in the Alliance’s latest edition of ‘First, Do No Harm,’ a report released last October that analyzed low-value health care services across the state. Award recipients provided the least amount of clinically unnecessary tests, treatments and procedures in 47 categories commonly regarded as overused by the national Choosing Wisely Program and the medical community, as measured by the Milliman MedInsight Health Waste Calculator.”

  • Avoiding low-value care: Learning to be an empowered consumer when you need a medical test or procedure. Cranston Herald. February 2020
    “As patients, the best defense against low-value care is to feel empowered to ask questions and have a better understanding of what healthcare services cost. Asking if there are less-expensive tests, treatments or procedures; researching what your insurance may cover; and being mindful about opting for generic drugs instead of brand-name drugs (when appropriate) can all help lower costs – and it’s perfectly okay for you to ask. Providers should welcome these questions – because we all want to take wasteful spending out of the system.”

  • Low-value medical tests are costly, can lead to harm. Daily News. February 2020
    “So what should patients do? If you have a medical abnormality that is in the gray area, it’s hard to leave it alone. Anxiety often drives the cascade. Still, patients in that situation need to ask a lot of questions about why further testing or medical procedures are necessary and whether more information would tell a doctor something new. Patients need to understand up front what the consequences might be.”