July 2019 Learning Network Resources

Upcoming Webinars and Discussions

Tuesday, August 20 at 4:00 PM EST
Join us for the Choosing Wisely Learning Network webinar, “Promoting value based health care education through STARS and UNITE” with speaker Dr. Christopher Moriates from UT Austin’s Dell Medical School.

Watch a recording of this Webinar.

Blogs, Issue Briefs, Opinion Pieces and More…

• Can Some Women Treated for Endometrial Cancer Forgo Radiation after Surgery? National Cancer Institute. July 2019
  “Some women with endometrial cancer may be able to receive less intensive treatment than is commonly given to patients without increasing the risk of the disease recurring within 5 years, according to the results of a randomized clinical trial.”
• EHR ‘Nudge’ Slashed Unneeded Scans Before Palliative Radiation. Medpage Today. July 2019
  “Over a 4-month period, a default imaging order in the EHR was added to specify no daily imaging during palliative radiotherapy, first at University of Pennsylvania Health System and then in community-based clinics in New Jersey and Pennsylvania.”
• Overtreatment of Low-Risk Thyroid Cancer. Medpage Today. July 2019
  “Identifying patients who might have an increased likelihood of overtreatment with RAI after surgery for low-risk thyroid cancer would help avoid unnecessary risk. To investigate the issue, the authors queried the NCI Surveillance, Epidemiology, and End Results (SEER) database to identify patients treated for newly diagnosed thyroid cancer during 2011 to 2013.”
• Langa KM, Burke JF. Preclinical Alzheimer Disease—Early Diagnosis or Overdiagnosis? JAMA Internal Medicine. July 2019
  The results of clinical trials of new treatments for Alzheimer disease (AD) have been consistently disappointing. The hope is that treatment of preclinical AD, which is defined as the presence of AD brain pathology without evidence of cognitive impairment, will be the breakthrough that keeps older adults’ memories and independence intact.”
• While addiction crisis raged, many surgeons overprescribed opioids, analysis shows. STAT. June 2019
  “As opioid addiction and deadly overdoses escalated into an epidemic across the U.S., thousands of surgeons continued to hand out far more pills than needed for postoperative pain relief, according to a KHN-Johns Hopkins analysis of Medicare data.”
• When one unnecessary procedure leads to many. Lown Institute. June 2019
  “When clinicians perform a diagnostic test or screening test ‘just to be safe,’ it often leads to follow-up tests and procedures which are not only costly, but increases patient stress and the risk of harm from complications.”
• In the drive to decrease low-value care, many don’t assess the right impacts on patients. Medical Xpress. June 2019
  “The review, published in the Journal of General Internal Medicine, looks at 117 different efforts aimed at reducing low-value care and how they measured the effects of these efforts.”

Journals

• Vaughn VM, Flanders SA, Snyder A, Conlon A, Rogers MAM, Malani AN, McLaughlin E, Bloemers S, Srinivasan A, Nagel J, Kaatz S, Osterholzer D, Thyagarajan R, Hsaiky L, Chopra V, Gandhi TN. Excess Antibiotic Treatment Duration and Adverse Events in Patients Hospitalized With Pneumonia: A Multihospital Cohort Study. Annals of Internal Medicine. July 2019
  “Patients hospitalized with pneumonia often receive excess antibiotic therapy. Excess antibiotic treatment was associated with patient-reported adverse events. Future interventions should focus on whether reducing excess treatment and improving documentation at discharge improves outcomes.”
• Dalal DS, Mbuyi N, Shah I, Reinert S, Hilliard R, Reginato A. Prescription Opioid Use among Acute Gout Patients Discharged from the Emergency Department. Arthritis Care & Research. July 2019
  “Despite the availability of effective treatments, opioids are commonly used for the management of acute gout. The study highlights an opportunity to curb the opioid epidemic among gout patients.”
• Herman AO. CRP Testing Can Safely Reduce Antibiotic Use for COPD Exacerbations. NEJM Journal Watch. July 2019
  “Using C-reactive protein (CRP) levels to guide treatment for chronic obstructive pulmonary disease (COPD) exacerbations can result in less antibiotic use without compromising clinical outcomes, a New England Journal of Medicine study finds.”
• Marcotte LM, Moriates C, Wolfson DB, Frankel RM. Professionalism as the Bedrock of High-Value Care. Academic Medicine. July 2019
  “Using professionalism as a key driver of practice change presents an important opportunity to shift from a deficit-based reactive model to one that is proactive and uses the concepts of intrinsic motivation and medical stewardship to effect high-value care.”
• Lim YZ, Chou L, Au RTM, KLMD Seneviwickrama, Cicuttini FM, Briggs AM, Sullivan K, Urquhart DM, Wluka AE. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review.  Journal of Physiotherapy. July 2019
  “Available data suggest that the information needs of people with low back pain are centred around their desire for a diagnosis, potentially contributing to expectations for and overuse of imaging.”
• Maratt JK, Kerr EA, Klamerua ML, Lohman SE, Froehlich W, Bhhatia S, Saini SD. Measures Used to Assess the Impact of Interventions to Reduce Low-Value Care: a Systematic Review. Journal of General Internal Medicine. June 2019
  “To characterize measures used to assess interventions to reduce low-value care, we extracted data on characteristics of studies, interventions, and measures. We then developed a framework to classify measures into categories.”
• Amin RM, Loeb AE, Hasenboehler EA, Levin AS, Osgood GM, Sterling RS, Stahel PF, Shafiq B. Reducing routine laboratory tests in patients with isolated extremity fractures: a prospective safety and feasibility study in 246 patients. BMC. June 2019
  “A prospective observational study was performed based on a new laboratory testing reduction protocol for 12 months at two tertiary care trauma centers.”
• Scherer LD, Lin G. Decision Aids for Prostate Cancer Screening—The True Potential Remains  Unknown. JAMA Internal Medicine. June 2019
  “Clinical trials have failed to resolve whether or to what degree screening using PSA tests help reduce prostate cancer–specific mortality, and it has long been clear that PSA screening tests increase the diagnosis of low-risk cancers and can lead to patient harm from potentially unnecessary biopsies and cancer treatment.”

Media Coverage

• The Promises and Pitfalls Of Gene Sequencing For Newborns. National Public Radio. July 2019
  “Sequencing a person’s DNA is now a routine task. That reality has left doctors looking for ways to put the technology to work.”
• Vitamins and Supplements Are a Waste of Money. MedScape. July 2019
  “Thirty billion dollars. That’s how much Americans spend every year on vitamins and supplements. And according to the most comprehensive analysis of their effects, most of that money is being wasted.”
• Spending on Low Value Services Slowed from 2014-2016. Modern Healthcare. June 2019
  “The analysis, published this week by consultancy Altarum and funded by the PhRMA Foundation, found spending growth on five low-value services decreased on average by 1.7% annually over the two-year period.”