January 2021 Learning Network Resources

February 16th @ 4PM EST

Join us for a webinar on “The Evolving Role of Community Health Workers as Trusted Messengers” with speaker Denise Smith from the National Association of Community Health Workers.Register here.

Trust in Healthcare

Still Happening: Pelvic Exams on Anesthetized Patients. Why? Medscape. January 2021

“The practice of medical students giving unconsented pelvic exams to women patients under anesthesia seems to be continuing, although recent new laws aim to change the situation.”

Delivering Covid-19 Vaccines by Building Community Trust. NEJM. January 2021

“Black and Hispanic communities have been hard hit by Covid-19, yet they have historical reasons to mistrust health care or defer vaccinations. Here’s how Parkland Health is working to rebuild trust in medical systems and health interventions.”

Understanding and Ameliorating Medical Mistrust Among Black Americans. The Commonwealth Fund. January 2021

“In this issue, we focus on the topic of mistrust of health care providers or systems among Black Americans, who are much more likely than whites to get seriously ill and die from COVID-19 but less willing to take the coronavirus vaccine. To draw lessons on ways of building trust with Black patients, we looked at clinical encounters in which the stakes of not addressing mistrust are high, including childbirth, childhood vaccination, and the care of patients with HIV, cancer, and substance use disorder. Many of the programs we found have focused on improving communication, increasing transparency, creating welcoming environments, and attending to access barriers, among other approaches for engaging patients who have been poorly served by the health care system.”

Choosing Wisely Resources:

Blogs, Issue Briefs, Opinion Pieces and More…

Radiology quality-improvement program could cut imaging spending by $433M if used across Medicare. Radiology Business. January 2021

“For the analysis, researchers queried the American College of Radiology’s R-SCAN database, which contains info from practices participating in dozens of distinct projects. Using recommendations from both Choosing Wisely and the ACR, those involved have targeted low-value imaging such as CTA for pulmonary embolism, adnexal cyst imaging follow-up and advanced imaging for lower back pain. All told, Wintermark et al. included more than 4,700 R-SCAN cases in their analysis, submitted by 27 distinct radiology practices between 2016 and 2019.”

Journals

Peden CJ, et alt. Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team. British Journal of Anaesthesia. February 2021

“In conclusion, we describe six evidence-based practice recommendations that if implemented across hospitals and health systems could reduce the incidence of perioperative neurocognitive disorders and associated harm. Anaesthetists should be key members and leaders of multidisciplinary clinical teams to implement change.”

Enwere EK, et alt. The mean abnormal result rates of laboratory tests ordered in the emergency department: shooting percentage insights from a multi-centre study. Canadian Journal of Emergency Medicine. January 2021

“This is the first study to measure MARR scores in an ED setting. While lower scores (close to 5%) are less optimal in principle, ideal scores will depend on the clinical context in which tests are used. However, once departmental benchmarks are established, MARR score-monitoring allows efficient tracking of ordering practices across millions of tests.”

Wintermark M, et alt. Predicted Cost Savings Achieved by the Radiology Support, Communication and Alignment Network from Reducing Medical Imaging Overutilization in the Medicare Population. Journal of the American College of Radiology. January 2021.

“We observed a substantial reduction in the costs associated with lesser value imaging in the R-SCAN cohort, totaling $260,000 over 3.5 months. When extrapolated to the Medicare population, the potential cost reductions associated with the decrease in lesser value imaging totaled $433 million yearly. If expanded broadly, R-SCAN interventions can result in substantial savings to the Medicare program.”

Innis K, et alt. Do I Need Proof of the Culprit? Decreasing Respiratory Viral Testing in Critically Ill Patients. Hospital Pediatrics. January 2021

“Since its introduction, respiratory viral PCR panel–testing proponents have advocated its use to reduce unnecessary health care resource use.1–3 However, studies in which authors evaluate the clinical impact of respiratory viral PCR panel testing have varied in their results and lacked consistent evidence to support changes in management or outcomes, including antibiotic administration, chest radiographic imaging, hospital admission, and hospital length of stay.3–7 In addition, commonly held beliefs include the need to test for isolation and cohort practices or to identify treatable viruses.”

Prodanuk M, et alt. Pediatric Urinary Tract Infections: A Choosing Wisely Initiative to Advance Antimicrobial Stewardship and Diagnostic Accuracy in the Emergency Department. Open Forum Infectious Disease. December 2020

“Implementation of a UTI diagnostic algorithm and urine culture callback system for uncomplicated pediatric UTIs reduced UTI misdiagnosis and promoted antimicrobial and resource stewardship in the ED. Future directions include improving UTI algorithm adherence through targeted clinician audit and feedback, plus sustainability planning.”

Hill CE, et alt. Increasing Out-of-Pocket Costs for Neurologic Care for Privately-Insured Patients. Neurology. December 2020

“An increasing number of patients pay out-of-pocket for neurologic diagnostic services. These costs are rising and vary greatly across patients and tests. The cost sharing burden is particularly high for the growing population with HDHPs. In this setting, neurologic evaluation might result in financial hardship for patients.”

Barlow B, et alt. Things We Do for No Reason™: Universal Venous Thromboembolism Chemoprophylaxis in Low-Risk Hospitalized Medical Patients. December 2020

“Inspired by the ABIM Foundation’s Choosing Wisely® campaign, the “Things We Do for No Reason™” (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion.”

Media

Study Finds No Benefit From Supplemental Oxygen During Labor. HealthDay. January 2021

“For decades, women have commonly been given oxygen during childbirth, but a new research review finds little evidence it benefits newborns. The American College of Obstetricians and Gynecologists recommends that women be given supplemental oxygen when fetal heart monitoring shows an abnormal heart rate. That’s based on the possibility that oxygen deprivation is causing the problem.”

CDC COVID-19 Response Team Physician to Help Kick Off RI Employer Crush COVID Challenge. Go Local Prov Business. December 2020

“Participating employers will win points for engaging in specified prevention activities such as promoting to employees’ adherence to COVID -19 social distancing at the workplace and at home, encouraging employees to get a flu shot, and use of Choosing Wisely materials to limit low-value care that is not only wasteful, but often causes health difficulties.”