January 2020 Learning Network Resources

Tuesday, February 18th at 4:00PM EST
Join us for our February webinar where speaker Beth Bortz, President and CEO for Virginia Center for Health Innovation, will discuss Smarter Care Virginia, a statewide collaborative to reduce low-value care.

Watch a recording of the Webinar.

Blogs, Issue Briefs, Opinion Pieces and More…

• What Is The Status Of Research On Low-Value Care? Health Affairs. January 2020
  “Overall, LVC has been an important area of research over the past five years (January 2014-March 2019), with a majority of efforts focused on developing a deeper understanding of the problem and building the evidence base for targeted interventions. Potential gaps emerged in areas such as health disparities and vulnerable populations, large-scale payment and practice transformation efforts, and practitioner and patient cultural factors related to practice change. More investigation would be needed to determine if these gaps are driven by funder priorities, researcher priorities, or broader sociopolitical barriers to pursuing these topics of research.”
   
• An alarming number of kids get unnecessary medical care, including antibiotics and cervical-cancer screenings. MarketWatch. January 2020
  “Thousands of U.S. children over one year received unnecessary medical services that didn’t benefit their health, a new study suggests. And while experts say much of the change must come from pediatricians, there are still ways for savvy parents to minimize the possibility.”
   
• Employers Struggle to Reduce Wasteful Health Care Spending. Workforce. January 2020
  “Employers have found ways to manage health care costs, but need to step up their efforts to tackle a more vexing problem — eliminating wasteful medical care spending.”
   
• An Essay on Choosing Wisely in Medicine. MD Magazine. December 2019
  “The subject of physician thinking has been a topic much discussed, largely because it’s physicians who are the most influential in driving healthcare costs either directly or indirectly. We are all influenced by our prior experience. We will never forget the case of finding a life-threatening disease that was picked up surreptitiously by a test or procedure ordered strictly on intuition. That great medical pickup is forever remembered while the hundreds of other times the test proves to be useless are long forgotten.”

Journals

• Raad M, Pakpoor J, Harris AB, Puvanesarajah V, Marrache M, Canner JK, Jain A. Opioid Prescriptions for New Low Back Pain: Trends and Variability by State. Journal of the American Board of Family Medicine. January 2020
  “We found that the overall frequency of opioid prescriptions for low back pain is decreasing nationally, which speaks favorably for future initiatives to change physician prescribing patterns. However, we identified that there is large variation in prescribing patterns among physicians in different states.”
   
• Floyd SB, Thigpen C, Kissenberth M, Brooks JM. Association of Surgical Treatment With Adverse Events and Mortality Among Medicare Beneficiaries With Proximal Humerus Fracture. JAMA Network Open. January 2020
  “This study found that higher rates of surgery for treatment of patients with PHF were associated with increased costs, adverse event rates, and risk of mortality. Orthopedic surgeons should be aware of the harms of extending the use of surgery to more clinically vulnerable patient subgroups.”
   
• Diem SJ, Greer NL, MacDonald R, McKenzie LG, Dahm P, Ercan-Fang N, Estrada A, Hemmy LS, Rosebush CE, Fink HA, Wilt TJ. Efficacy and Safety of Testosterone Treatment in Men: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Annals of Internal Medicine. January 2020
  “In older men with low testosterone levels without well-established medical conditions known to cause hypogonadism, testosterone therapy may provide small improvements in sexual functioning and quality of life but little to no benefit for other common symptoms of aging. Long-term efficacy and safety are unknown.”
   
• Qin J, Saraiya M, Martinez G, Sawaya GF. Prevalence of Potentially Unnecessary Bimanual Pelvic Examinations and Papanicolaou Tests Among Adolescent Girls and Young Women Aged 15-20 Years in the United States. JAMA Internal Medicine. January 2020
  “This analysis found that more than half of BPEs and almost three-quarters of Pap tests performed among young women aged 15 to 20 years during the years 2011 through 2017 were potentially unnecessary, exposing women to preventable harms. The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking.”
   
• Ma X, Wang R, Long JB, Ross JS, Soulos PR, Yu JB, Makarov DV, Gold HT, Gross CP. The cost implications of prostate cancer screening in the Medicare population. Cancer. January 2020
  “Recent debate about prostate-specific antigen (PSA)-based testing for prostate cancer screening among older men has rarely considered the cost of screening. A population-based cohort of male Medicare beneficiaries aged 66 to 99 years, who had never been diagnosed with prostate cancer at the end of 2006 (n = 94,652), was assembled, and they were followed for 3 years to assess the cost of PSA screening and downstream procedures (biopsy, pathologic analysis, and hospitalization due to biopsy complications) at both the national and the hospital referral region (HRR) level. Medicare prostate cancer screening-related expenditures are substantial, vary considerably across regions, and are positively associated with rates of cancer diagnosis.”
   
• Feldman DE, Carlesso LC, Nahin RL. Management of Patients with a Musculoskeletal Pain Condition that is Likely Chronic: Results from a National Cross Sectional Survey. The Journal of Pain. December 2019
  “We outlined in a representative sample of Americans what treatments are being prescribed for new cases of likely chronic musculoskeletal pain. Opioid prescription was double that of physical therapy. Using the electronic medical record was associated with more opioid prescription- a novel finding that should be corroborated by future research.”
   
• Thom R, Farrell HM. Neuroimaging in psychiatry: Potentials and pitfalls. Psychiatry 2.0. December 2019
  “While neuroimaging is a quickly evolving research tool, empirical support for its clinical use remains limited. The hope is that future neuroimaging research will yield biomarker profiles for mental illness, identification of risk factors, and predictors of vulnerability and treatment response, which will allow for more targeted treatments.”
   
• Nevedal AL, Lewis ET, Wu J, Jacobs J, Jarvik JG, Chou R, Barnett PG. Factors Influencing Primary Care Providers’ Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study. Journal of General Internal Medicine. December 2019
  “Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.”
   
• Morgan T, Wu J, Ovchinikova L, Lidner R, Blogg S, Moorin R. A national intervention to reduce imaging for low back pain by general practitioners: a retrospective economic program evaluation using Medicare Benefits Schedule data. BMC Health Services Research. December 2019
  “The 2013 NPS MedicineWise LBP program reduced CT scan referral by GPs, in line with the program’s messages and clinical guidelines. Reducing this low-value care produced savings to the health system that exceeded the costs of program implementation.”
   
• Macy E. Addressing the epidemic of antibiotic “allergy” over-diagnosis. Annals of Allergy, Asthma & Immunology. December 2019
  “Audit and feedback, to help ensure adherence to Choosing Wisely recommendations and good antibiotic stewardship practices, can help reduce inappropriate antibiotic use. Restructuring EHRs to facilitate correct drug intolerance reporting, along with active antibiotic allergy delabeling programs, can help stem this epidemic.”

Media

• Coverage Overwhelmed by medical bills, and finding help on TikTok. The New York Times. January 2020
  “The sky-high (and often unexpected) costs of emergency care are investigated regularly by news outlets, and experts have said that requesting an itemized bill might help bring costs down in some cases. But medical costs can be bewildering, and that information doesn’t always make its way to the people who need it.”
   
• Dense Breasts: Who Needs More Imaging? Medscape. January 2020
  “A natural desire to help women and impatience on the part of physicians and patients for definitive evidence regarding the most beneficial approach to breast density is driving the current push for additional screening for women whose breast cancers may be missed by mammography. I certainly have wondered if my first patient, and others I’ve since diagnosed with interval cancers, may have lived longer or had fewer treatment harms if MRI had advanced their time to diagnosis. But mandating discussions about breast density in the absence of evidence-based guidance could easily do more harm than good.”
   
• How one medical checkup can snowball into a ‘cascade’ of tests, causing more harm than good. The Washington Post. January 2020
  “What’s becoming clear is that we also need better ways to navigate cascades once they begin — to maximize any upside and minimize the harm. For patients, that means understanding tests come with trade-offs. For doctors, it’s setting expectations about what tests might reveal, framing results for what they are, and working with patients to decide the next steps informed by evidence and patient preferences.”
   
• Alzheimer’s tests soon may be common, raising a difficult question: Would you want to know if you were getting the disease? Chicago Tribune. December 2019
  “There is a blood test on the horizon that can detect beta amyloid, and researchers are experimenting with scans to look for another protein, called tau, also characteristic of Alzheimer’s. As this sort of diagnostic testing becomes widespread, more people who fear their memories are slipping will face a difficult question: Would I really want to know if I were getting Alzheimer’s disease?”