December 2020 Learning Network Resources

Tuesday, January 19th @ 4PM EST

Please join us for a webinar on Building a Better Health Care System Post-COVID with Corinna Sorenson, PhD from the Duke-Margolis Center for Health Policy. Register here.

Trust In Healthcare

Using Mistrust, Distrust, and Low Trust Precisely in Medical Care and Medical Research Advances Health Equity. American Journal of Preventive Medicine. November 2020

“This paper refines the way that patient’s trust, mistrust, and distrust are conceptualized. In particular, it focuses on clarifying the distinctions among low levels of trust, mistrust, and distrust, which will strengthen the pillars on which more accurate and effective measures, programs, and policies can be created to promote equity in healthcare utilization and medical research.”

Dr. Fauci on Public Trust in Science. The Hastings Center. November 2020

“Dr. Anthony Fauci and Mildred Solomon explored the ethical issues raised by the erosion of trust in science in a virtual discussion hosted by The Hastings Center on November 19. The nation’s top infectious diseases official and the Hastings president looked at how we can improve public understanding of complex scientific issues in this highly polarized, fraught time.”

Ignoring the Sins of Our Patients. Medscape. November 2020

“For many — the exiled, the ostracized, and the incarcerated — society has judged and the law has condemned. But when they enter the house of medicine, we still treat them with the same compassion and care as everyone else. Every person is a life, and every life is worth saving.”

Warren RC, et alt. Trustworthiness before Trust — Covid-19 Vaccine Trials and the Black Community. The New England Journal of Medicine. October 2020

“When Covid-19 vaccines are eventually approved by the FDA, their success in Black and other communities will depend on whether members of these communities not only trust that they are safe and effective, but also believe that the organizations offering them are trustworthy.”

Choosing Wisely Resources:

Blogs, Issue Briefs, Opinion Pieces and More…

Inappropriately prescribed antibiotics will likely accompany the winter surge of Covid-19. STAT. November 2020

“Recognizing the risk of a surge of antibiotic prescribing is the first step toward encouraging physicians and patients to use antibiotics appropriately, and not for viral illnesses. It is more important than ever for physicians to take the time to talk to their patients about the appropriate use of antibiotics and reassure them that not prescribing them can be the medically right thing to do. Ideally, this will create a feedback loop such that more judicious antibiotic use in one visit may result in fewer antibiotics into the future, and help establish new norms on when antibiotics are needed.”

How to Avoid Overuse of Oral Steroids in Severe Asthma. Living Allergic. November 2020

“When prescribing oral steroids, doctors should make sure that the people taking them are actually being helped by the drugs, the presenters stressed. Physicians also need to monitor whether patients are using their inhaled steroid medications as prescribed, and are using proper inhaler technique. This ensures patients are getting the most benefit from controller medications and are not relying on oral steroids unnecessarily.”

Journals

Speer M, et alt. Excess Medical Care Spending: The Categories, Magnitude, and Opportunity Costs of Wasteful Spending in the United States. AJPH. November 2020 

“Aggregate estimates of waste varied from $600 billion to more than $1.9 trillion per year, or roughly $1800 to $5700 per person per year. Wider recognition by public health stakeholders of the human and economic costs of medical waste has the potential to catalyze health system transformation.”

Wang RC, et alt. Trends in Imaging for Suspected Pulmonary Embolism Across US Health Care Systems, 2004 to 2016. JAMA. November 2020

“From 2004 to 2016, rates of chest CT and CTPA for suspected PE continued to increase among adults but at a slower pace in more contemporary years. Efforts to combat overuse have not been completely successful as reflected by ongoing growth, rather than decline, of chest CT use. Whether the observed imaging use was appropriate or was associated with improved patient outcomes is unknown.”

Fenelus M, et alt. Choosing wisely during the COVID-19 pandemic: optimising outpatient cancer care while conserving resources with a new algorithm to report automated ANC results. BMJ. November 2020

“The need for more efficient patient management is highlighted during the COVID-19 pandemic. Reduction in staffing and the necessity for social distancing in the clinical laboratory as well as patient care areas has led healthcare institutions to reconsider established workflows. A ‘CBC with ANC only’ test offers an opportunity to preserve resources without adversely impacting patient care.”

Barry K, et alt. Evidence to Avoid Overtesting and Overuse in Diabetes Mellitus and Other Diseases. American Family Physician. November 2020

“What can physicians do to avoid overuse? Start by asking the right questions. Will this screening test result in better patient outcomes beyond simply adding new diagnoses? What will I do with the results of the monitoring test I am about to order—is it really necessary or am I just checking a box? For treatment, does one choice outweigh others because of superiority using the STEPS framework, or am I selecting a treatment because it is trendy and new? To answer these questions and to stay updated on quickly changing medical information, physicians should use secondary sources, such as evidence-based summaries.”

Culbertson L, et alt. Examining the Relationship between Cost and Quality of Care in the Neonatal Intensive Care Unit and Beyond. Children. November 2020

“As we strive to understand the variation in clinical outcomes, we must also strive to understand the variation in costs and embrace the opportunity to reduce each rather than assume that one hospital has better outcomes because they are resource rich and allocate higher dollars. In addition, we should include a “health equity lens” to ensure that our value-based care works to eliminate disparities between groups in health care and we are truly achieving improved outcomes for all of our patients.”

Ahrari A, et alt. Appropriateness of laboratory tests in the diagnosis of inflammatory rheumatic diseases among patients newly referred to rheumatologists. Joint Bone Spine. November 2020

“Despite the recommendations by CRA Choosing Wisely Campaign, at least 50% of laboratory investigations, including RF, ANA, ENA, and anti-dsDNA, are inappropriately ordered. More selective ordering of the above tests would lead to marked cost reduction.”