December 2019 Learning Network Resources

Upcoming Webinars and Discussions

Tuesday, January 21^st at 4:00PM EST
Please join us for our webinar on the High Value Care Culture Survey with Dr. Reshma Gupta, Executive Medical Director of Population Health and Value at University of California Davis.

Watch a recording of the webinar.

Blogs, Issue Briefs, Opinion Pieces and More…

• ASH acknowledges three Choosing Wisely Champions for their ‘elegant, implementable strategies.’ Healio. December 2019
  “ASH named three Choosing Wisely Champions today at its Annual Meeting and Exposition, recognizing clinicians who have implemented projects to improve quality and reduce costs at their institutions.”

• Many older adults and caregivers unaware of drug risks, survey finds. Lown Institute. November 2019
  “Overall, only half of survey respondents said that a health care provider has talked to them about stopping medications. This is discouraging but not surprising, given that many clinicians do not have the time to engage in conversations about medications, nor are they reimbursed for doing so.”
   
• Rethink the Strip: Stopping Glucose Monitoring for Non-Insulin Treated Type 2 Diabetes. Patient-Centered Outcomes Research Institute. November 2019
  “PCORI funds Dissemination and Implementation projects to increase awareness and promote the use of PCORI research findings to improve healthcare practices and health outcomes. This project is proposing to conduct dissemination and implementation activities for the results of the research project: Does Daily Self-Monitoring of Blood Sugar Levels Improve Blood Sugar Control and Quality of Life for Patients with Type 2 Diabetes Who Do Not Use Insulin? — The Monitor Trial. The project team created a program, Rethink the Strip, to help primary care clinicians, patients, and health insurers work on stopping daily blood sugar testing for people with type 2 diabetes who don’t need insulin. The team wants to improve the program before releasing it nationally.”
   
   

Journals

• Upvall MJ, Bourgault AM, Pigon C, Swartzman CA. Exemplars Illustrating De-implementation of Tradition-Based Practices. Critical Care Nurse. December 2019
  “This article explores the de-implementation process, examining its barriers and facilitators. Three critical care exemplars of tradition-based practices are presented and examined through the lens of de-implementation. Barriers and facilitators related to de-implementing these tradition-based practices are described, with an emphasis on the roles of various stakeholders and the need to overcome cognitive dissonance and psychological bias.”
   
• Singh K, Balthazar P, Dusak R, Horný M, Hanna TN. Clinical Yield of Routine Chest Radiography after Ultrasound-Guided Thoracentesis. Academic Radiology. December 2019
  “Following ultrasound-guided thoracentesis, the incidence of pneumothorax requiring chest tube decompression is only 1 in 170. Of the 1 in 30 patients who develop a pneumothorax, only 1 in 6 require a chest tube. This information can inform procedural consent discussions as well as future guidelines about the necessity of routine postprocedural chest radiography.”
   
• Ray MJ, Tallman GB, Bearden DT, Elman MR, McGregor JC. Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study. BMJ. December 2019
  “This nationally representative study of ambulatory visits identified a large number of prescriptions for antibiotics without a documented indication. Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting. This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation.”
   
• Himelfarb J, Lakhani A, Shelton D. Appropriate use of CT for patients presenting with suspected renal colic: a quality improvement study. BMJ Open Quality. November 2019
  “CT use for renal colic has increased costs, radiation exposure and frequently does not alter management. Consequently, choosing wisely (CW) recommends avoiding CT imaging of otherwise healthy patients younger than 50 years presenting with symptoms of recurrent, uncomplicated renal colic. We evaluated the utilisation of CT imaging for this subgroup of patients and subsequently implemented a quality improvement initiative with an aim to reduce unnecessary radiation exposure.”
   
• Salem-Schatz S, Grisworld P, Kandel R, Benjamin-Bothwell S, DeMaria A, McElroy N, Bolstorff B, McHale E, Doron S. A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long-Term Care. Journal of the American Geriatrics Society. Journal of the American Geriatrics Society. November 2019
  “Suspected urinary tract infection (UTI) is the most common indication for antibiotic use in long‐term care (LTC). Due to the high prevalence of asymptomatic bacteriuria, for which antibiotics are not warranted, these antibiotics are frequently unnecessary. We implemented a collaborative quality improvement program to improve the management of suspected UTI in LTC residents by increasing awareness of current guidelines, with a focus on decreasing treatment in the absence of symptoms.”
   
• Chen D, Bhambhvani HP, Hom J, Mahoney M, Wintermark M, Sharp C, Ratliff J, Yi-Ren C. Effect of Electronic Clinical Decision Support on Imaging for the Evaluation of Acute Low Back Pain in the Ambulatory Care Setting. World Neurology. November 2019
  “The present study demonstrates the effectiveness of a simple, low-cost clinical decision support tool in reducing imaging rates for patients with acute low back pain. We also identify reasons why providers order imaging outside of clinical guidelines.”
   
• Maduke T, Qureshi B, Goite Y, Gandhi K, Bofarrag F, Liu L, Suazo M, Khan S, Basnyat S, Dhital S, Kawsar H. Monitoring the Use of Telemonitor: A Resident-run Quality Improvement Initiative Decreases Inappropriate Use of Telemonitor in a Community Hospital. Cureus. November 2019
  “Cardiac telemetry is an important tool to detect life-threatening conditions in hospitalized patients but is used widely and inappropriately. We sought to assess current usage and improve the appropriate use of telemetry in a community hospital. Our results highlight that change in practice requires sustained education interventions.”
   
• Fenelus M, Golden RM, Graham T, So RJ, Bautista JL, Peerschke EIB. Choosing Wisely: Optimizing Outpatient Cancer Care and Conserving Resources with a New Algorithm to Report Automated ANC Results in the Presence of Analyzer Flags. American Society of Hematology. November 2019
  “The complete blood cell count (CBC) with white blood cell (WBC) differential is an essential laboratory test used to screen cancer patients prior to chemotherapy. We performed a retrospective analysis of ANC test results (N=1422) performed for patients with solid tumor malignancies across 5 outpatient sites, over the course of one month. The accuracy of automated ANC results (Sysmex XN) was assessed by comparison to the manual differential using Rumke statistics. These findings support the concept of creating a distinct test order for “CBC with ANC only,” when the ANC is required for the initiation of chemotherapy in patients with solid tumors.”
   

• Shaker M, Oppenheimer J, Wallace D, Lang DM, Rambasek T, Dykewicz M, Greenhawt M. Optimizing Value in the Evaluation of Chronic Spontaneous Urticaria: A Cost-Effectiveness Analysis. The Journal of Allergy and Clinical Immunology. November 2019
  “Chronic spontaneous urticaria (CSU) affects approximately 1% of the general population. The cost-effectiveness of routine laboratory testing for secondary causes of CSU has not been formally evaluated. A Markov model using cohort analysis and microsimulations was created for adult patients aged 20 years, over a 10-year time horizon, randomized to receive screening laboratory testing or a no-testing approach. In CSU, the likelihood of clinical improvement from laboratory testing is very low, and testing is not cost-effective. These data support recommendations to not routinely perform laboratory testing in patients with CSU with otherwise normal histories and physical evaluations.”
   
• Bakker MF, de Lange SV. Pijnappel RM, Mann RM, Peeters PHM, MonninkhoF EM, Emaus MJ, Loo CE, Bisschops RHC Lobbes MBI, de Jong MDF, Duvivier KM, Veltman J, Karssemeijer N, de Koning HJ, van Diest PJ, MalI WPTM, van den Bosch MAAJ, Veldhuis WB, van Gils CH. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. The New England Journal of Medicine. November 2019
  “Extremely dense breast tissue is a risk factor for breast cancer and limits the detection of cancer with mammography. Data are needed on the use of supplemental magnetic resonance imaging (MRI) to improve early detection and reduce interval breast cancers in such patients. The use of supplemental MRI screening in women with extremely dense breast tissue and normal results on mammography resulted in the diagnosis of significantly fewer interval cancers than mammography alone during a 2-year screening period.”

Media Coverage

• Choosing Wisely: 5 Recommendations on Testing to Avoid in Pediatric Hematology. Medscape. December 2019
  “The list, which was produced by an expert panel with representatives from the American Society of Hematology and the American Society of Pediatric Hematology/Oncology (ASPHO), includes five tests or procedures that are considered unnecessary. The recommendations were released at the annual meeting of the American Society of Hematology.”
   
• With no national reporting system, volume of medical errors is still unknown. Modern Healthcare. November 2019
  “For the purpose of improving patient safety, wouldn’t it help to know whether the number of patients who die each year due to preventable medical errors in U.S. hospitals is 44,000 or 400,000? The magnitude of risk obviously matters a lot to patients and their families. Patient safety experts and healthcare leaders say they’d like more accurate statistics about how many people are killed and injured, by what types of errors or harms, and in what clinical settings, so they can better target their improvement efforts.”

•  Your diagnosis was wrong. Could doctor bias have been a factor? The Washington Post. November 2019
  “Newman-Toker found that judgment errors accounted for 86 percent of 55,377 medical malpractice claims he evaluated where misdiagnosis led to death or disability. The judgment blame bucket includes an assortment of knowledge gaps, inattentions, misinterpretations and what Angie Rosen believes led to the misdiagnosis of her stroke in August: implicit bias.”
   
• Bayhealth recognized for reducing low-yield scans. Dover Post. November 2019
  “Bayhealth was recently recognized for its efforts to successfully reduce low-yield imaging scans in its emergency departments. As part of the CMS Transforming Clinical Practice Initiative with the support and guidance of Bayhealth Clinical Integration and HealthVisions Delmarva Practice Transformation Network, Bayhealth’s emergency physicians, radiologists and hospitalists have been collaborating to decrease low-yield imaging scans in patients receiving care at Bayhealth’s three EDs. The collaborative team has been following American College of Radiology’s appropriateness criteria through Choosing Wisely guidelines and resources from the American College of Emergency Physicians.”