March 2021 Learning Network Resources

Tuesday, April 20th @ 4PM EST

Join us for “Tackling COVID-19 Vaccine Hesitancy,” with speaker Sandra Quinn, PhD, Maryland Center for Health Equity, University of Maryland. Register here.

Trust in Healthcare

“An analysis of the demographics of a decade’s worth of vaccine clinical trials has found that Black Americans, Latinos, American Indians, and Alaskan Natives, as well as people age 65 and older, were underrepresented as participants within these studies, though most of the differences, when compared with the U.S. population, were not especially large. Adult women, on the other hand, were found to be overrepresented.”

“America’s more than 60 million Latinos — like other people of color — have been disproportionately affected by the virus, and many are struggling with issues like a lack of knowledge about the shots, state vaccine websites that don’t have Spanish instructions, ways to find appointments in their communities and fears they could be targeted for immigration enforcement.”

“Why does this happen? Our health care delivery system is fragmented, divided between community hospitals (often public hospitals) and private ones. Private hospitals often cherry-pick wealthier patients with private insurance and avoid taking patients with public insurance, funneling poorer and sicker patients to the public hospitals. In the case of MLK hospital, only 4% of their patients have private insurance, according to the Times.”

“With their deep roots in the community, many of these workers were disappointed when they were not called on to help initially in the pandemic. Community health workers often work on grant-funded projects with a specific goal, such as improving blood sugar control among people with diabetes. When the pandemic shutdown suspended those programs, many found themselves without a job.”

“The scandal of surprise bills has been tolerated far too long. The new law is an important step forward — but it’s too soon to declare it a success. First, it must be made to work.”

“The study’s findings suggest that the inequalities underlying racial disparities in COVID-19 infection and mortality in the general population may also be associated with differences in mortality among nursing home residents with COVID-19 infection.”

Blogs, Issue Briefs, Opinion Pieces and More…

  • UTIs Treated Inappropriately Everywhere. Medpage Today. February 2021
    “A majority of women with uncomplicated urinary tract infections (UTIs) received inappropriate antibiotics or continued treatment beyond the recommended duration, a review of almost 700,000 cases showed.”

Journals

“This cross-sectional study found that among individuals with fee-for-service Medicare receiving any of 32 measured services, low-value care use and spending decreased marginally from 2014 to 2018, despite a national education campaign in collaboration with clinician specialty societies and increased attention on low-value care. While most use of low-value care came from 3 services, 1 of these was opioid prescriptions, which increased over time despite the harms associated with their use. These findings may represent several opportunities to prevent patient harm and lower spending.”

“The past two decades have seen a paradigm shift in the way we use imaging when managing low back pain (LBP). Imaging was once a routine part of the diagnostic workup for most cases of LBP. Evidence now indicates that imaging is useful only in the small subgroup of patients for whom there is suspicion of red flag conditions.”

“Interfacility variation demonstrates a performance gap and an opportunity for formal deimplementation efforts targeting each procedure. Several facility-level characteristics were associated with differential deimplementation and performance.”

“We developed a diagnostic overuse index that identifies hospitals with high levels of diagnostic intensity by comparing negative diagnostic testing rates for common diagnoses.”

“Our study found that evidentiary rationales for low-value care vary substantially, with most recommendations relying on clinical evidence. Broadening the evidence base to incorporate cost-effectiveness evidence can help refine the definition of “low-value” care to reflect whether an intervention’s costs are worth the benefits. Developing a consensus grading structure on the strength and evidentiary rationale may help improve de-implementation efforts for low-value care.”

“Marked variation exists in whether a breast core biopsy is performed prior to initial breast surgery, which may represent unnecessary surgery on individual patients. Providing surgeon-specific feedback on guideline compliance may reduce unwarranted variation.”

“An elevated BMIP may increase difficulty in visualizing the appendix, resulting in inaccurate or equivocal findings. This risk is seen specifically in obese males. If US findings do not correlate with clinical assessment in obese children with abdominal pain, further evaluation may be warranted.”

Media

“In mid-February, Toronto Public Health reported that January 2021 was a record-setting month — not for COVID-19, but for opioid use. Paramedics reported 333 non-fatal and 38 fatal calls.”

“Neoadjuvant chemotherapy is the treatment of choice for newly diagnosed inflammatory or unresectable breast cancer, as well as locally advanced disease that might be rendered operable with neoadjuvant therapy, according to a new guideline from the American Society of Clinical Oncology (ASCO).”