August 2020 Learning Network Resources

Tuesday, September 15, @ 4:00 PM EST

Please join us for a webinar on Delaware’s statewide Choosing Wisely inspired advanced illness collaboration with speaker Dr. Rob Dressler, quality and safety officer at Christiana Care. Register in advance for this meeting.

 

Blogs, Issue Briefs, Opinion Pieces and More…

  • Pediatric Advanced Imaging: When Is Less More? MedPage Today. August 2020
    “For example, physicians may feel pressured to make a timely diagnosis within an ED visit, or don’t want to risk malpractice for missing a diagnosis, Marin said. ‘A family comes to the ED with their child’s symptom or condition and they’ve waited for several hours and paid a copay,’ Marin said. ‘It can be challenging to not do a test and to ask them to do what we call ‘watchful waiting.’ As a society, we have less tolerance for that today than we have in the past.’”

 

  • Analysis: When Is a Coronavirus Test Not a Coronavirus Test? Kaiser Health News. July 2020
    “Coronavirus testing in the United States has been bungled in every way imaginable. The latest fiasco is perhaps the most Kafkaesque: Tests are now widely available in many places, but results are often taking so long to come back that it is more or less pointless to get tested.”

 

  • Covid-19: an opportunity to reduce unnecessary healthcare. BMJ. July 2020
    “This pandemic has provoked the best of human compassion and solidarity, but those who manage our health systems still face extraordinary challenges responding to covid-19 and preparing for the second wave. Looking beyond the crisis, our collective learning about the effects of the large falls in healthcare use can help inform and intensify efforts to reduce unnecessary care. This in turn can prevent avoidable harm to patients, enhance healthcare equity, and improve the sustainability of health systems everywhere.”

 

Journals

  • McKay VR, et alt. Better Service by Doing Less: Introducing De-implementation Research in HIV. Implementation Science. August 2020
    “The course of HIV research has led to a multitude of interventions to prevent and treat HIV. With the arrival of more effective interventions comes the need to end, or de-implement, less effective interventions. Existing studies have identified a set of HIV-specific interventions appropriate for de-implementing and described the persistence of interventions that should be ended. However, to our knowledge, strategies to successfully promote appropriate de-implementation of HIV-specific interventions have not been examined. De-implementing interventions that are no longer needed is an opportunity to improve the quality and effectiveness of HIV services. Opportunities to expand this field of research abound.”

 

  • Chen DW, et alt. Physician-Reported Misuse of Thyroid Ultrasonography. JAMA Surgery. August 2020
    “In the US, there is an ongoing national dialogue about avoiding unnecessary medical tests, with the Choosing Wisely campaign recommending against ordering thyroid ultrasonographic examinations for abnormal thyroid function test results. However, despite this national dialogue, little is known about physician-reported use of thyroid ultrasonography, a known driver of thyroid cancer incidence.”

 

 

 

  • Moss JL, et alt. Geographic Variation in Overscreening for Colorectal, Cervical, and Breast Cancer Among Older Adults. JAMA. July 2020
    “In this study, overscreening for cancer among older adults was high, particularly for women living in metropolitan areas. Overscreening could be associated with health care access and patient-clinician relationships. Additional research on why overscreening persists and how to reduce overscreening is needed to minimize risks associated with cancer screening among older adults.”

 

Media Coverage

  • 10 Ways to Improve Patient Interactions While Wearing a Mask. Medpage Today. August 2020
    “Our hope is that these 10 strategies reassure clinicians who are feeling exhausted and frustrated by the communication challenges while wearing a mask that there are many ways to connect with patients when genuine smiles and sympathetic touch are restricted. Any combination of these strategies can help you provide compassionate care from behind a mask.”

 

  • Episode 11: Are you Choosing Wisely during the pandemic? NPS Medicinewise. August 2020
    “In this episode, Steve Morris speaks with Dr Simon Judkins, an emergency physician working in Victoria at one of the Choosing Wisely Australia Champion Health Service hospitals. They discuss how the Choosing Wisely principles, particularly around resource stewardship and the importance of conversations about what care is necessary, have been relevant during the COVID-19 pandemic. They also look at how new pandemic guidance from Choosing Wisely Australia will help health professionals and consumers navigate the current environment.”

 

  • Physicians urge peers to quash ‘low value’ use of daily chest x-rays in the ICU. Radiology Business. July 2020
    “Advances in technology, such as ultrasound and modern ventilators that closely monitor pulmonary mechanics, have further rendered daily CXR moot. The writers suggested solutions such as ICU policy changes, evidence-based education and clinician engagement to begin addressing this issue. The practice can continue in certain specific scenarios, they added, including monitoring certain catheters, but largely this practice should disappear. ‘CXRs should otherwise be reserved for specific clinical concerns, such as new hypoxemia,’ Maley and Stevens said. ‘By eliminating the need to review daily CXRs for each patient, clinicians may also increase time spent at the bedside and focus on higher-value data that meaningfully inform care,’ they added.”

 

  • Christopher Labos: The pandemic’s lessons for health-care spending. The Province. July 2020
    “One of the interesting things I hope we take away from the pandemic is that much of the routine care we offer up to patients may not be necessary. Many patients had their routine follow-ups delayed by a few months or converted into telemedicine visits, and were no worse off as a result. While COVID-19 claimed many lives not only directly, but indirectly by delaying important medical care, it may also have shown us that a lot of our medical care is unnecessary. If we can trim the fat of unnecessary medical testing, then we may better secure our health-care system to face the challenge of our aging population.”