November 2019 Learning Network Resources

Upcoming Webinars and Discussions

Tuesday, January 21st at 4:00PM EST
We’ll be skipping our monthly webinar in December, but please join us for our webinar on the High Value Care Culture Survey with Dr. Reshma Gupta, Executive Medical Director of Population Health and Value at University of California Davis.

Watch a recording of the webinar.

New Resources

Blogs, Issue Briefs, Opinion Pieces and More…

  • Choosing Wisely: When to Question Tests, Procedures or Treatment for Pediatric Surgery. American Academy of Pediatrics. November 2019
    “The American Academy of Pediatrics (AAP), as part of the national Choosing Wisely® campaign, has developed a new list of medical tests, treatments and procedures that may be over-utilized and not necessary in many cases — this time focusing on pediatric surgery.”
  • A Million-Dollar Marketing Juggernaut Pushes 3D Mammograms. Kaiser Health News. October 2019
    “A KHN investigation found that manufacturers, hospitals, doctors and some patient advocates have put their marketing muscle ― and millions of dollars ― behind 3D mammograms. The juggernaut has left many women feeling pressured to undergo screenings, which, according to the U.S. Preventive Services Task Force, haven’t been shown to be more effective than traditional mammograms.”
  • Path to better imaging utilization is clear: straight talk. AMA. October 2019
    “Radiologists worked with emergency physicians, primary care physicians and other specialists to educate them about when it is best to order images. They created education materials that could be handed to patients to explain why a certain imaging test would not yield much of value. Also, they looked at data to determine how often low-yield images were being ordered—images that exposed patients to radiation when they weren’t going to help make a diagnosis.”
  • Measuring low-value care: learning from the US experience measuring quality. BMJ Quality & Safety. October 2019
    “There is wide recognition that promoting healthcare value involves decreasing ‘low-value’ services—care without clinical benefit, little benefit compared with cost or disproportionate potential harm. In response, policymakers, insurers and individual healthcare systems must work together to create and track measures of low-value care. In the USA, a number of states have begun to use such measures to characterise low-value care delivered by healthcare provider organisations. Many of the existing measures have been derived from the national Choosing Wisely campaign.”


  • Wiencek CA, Kleinpell R, Moss M, Sessler CN. Choosing Wisely in Critical Care: A National Survey of Critical Care Nurses. American Journal of Critical Care. November 2019
    “Acute and critical care nurses are directly involved with measures to reduce unnecessary testing and treatments. Greater awareness and championing of the Choosing Wisely recommendations by acute and critical care nurses can help to promote high-value care for acute and critically ill patients.”
  • Khoury M, Tolentino M, Haj-Ahmad Z, Lilek C, Law M. Assessing Appropriateness of CT and MRI Referrals for Headache and Lumbar: A Canadian Perspective on Patient-Centered Referrals. Journal of Medical Imaging and Radiation Sciences. November 2019
    “Inappropriate diagnostic imaging is a burgeoning problem within the Canadian healthcare system and imposes considerable burdens to efficiency and timeliness of care. Low back pain and headaches affect an immense portion of the general population and have become exceedingly common complaints from patients seeking diagnostic imaging from primary care physicians. A total of 399 magnetic resonance imaging (MRI) and computed tomography (CT) requisitions for lumbar and head scans were reviewed and assessed for appropriateness in concordance with published Choosing Wisely guidelines for head and lumbar diagnostic imaging. After collection and review of 251 requisitions in the postintervention period, incomplete referrals dropped from 36.3% to 13.15%.”
  • DiDiodato G.Estimating the Impact of Words Used by Physicians in Advance Care Planning Discussions: The “Do You Want Everything Done?” Effect.Critical Care Explorations. October 2019
    “This phrase is predicted to dramatically reduce the likelihood of withdraw life-sustaining therapy even in medically nonbeneficial scenarios and potentially contribute to low-value end-of-life care and outcomes. The immediate cessation of this term should be reinforced in medical training for all healthcare providers who participate in advance care planning.”
  • Bruno C, Pearson SA, Daniels B, Buckley NA, Schaffer A, Zoega H. Passing the acid test? Evaluating the impact of national education initiatives to reduce proton pump inhibitor use in Australia. BMJ Quality & Safety. October 2019
    “Proton pump inhibitor (PPI) use is widespread. There have been increasing concerns about overuse of high-dose PPIs for durations longer than clinically necessary. Our findings suggest that these educational initiatives alone were insufficient in curbing overuse of PPIs on a national level. Concerted efforts with policy levers such as imposing tighter restrictions on subsidised use of PPIs may be more effective. Noting low strength esomeprazole is not publicly subsidised in Australia, availability of these preparations may also facilitate more appropriate practice.”
  • Chestnut GT, Benfante N, Barham D, Dean LW, Tin A, Sjoberg DD, Scardino PT, Eastham JA, Ehdaie B, Colean JA, Donahue TF, Toujier KA, Laudone VP. Routine Postoperative Hemoglobin Assessment Poorly Predicts Transfusion Requirement Among Minimally Invasive Radical Prostatectomy Patients. American Urological Association. October 2019 
    “As transfusion following minimally invasive radical prostatectomy is rare, scheduled postoperative hemoglobin assessments in the absence of symptoms are unnecessary to recognize bleeding events. The largest hemoglobin difference between men who did and did not receive transfusion was seen 14 hours postoperatively. This single hemoglobin evaluation is sufficient.”
  • Ganguli I, Simpkin AL, Lupo C, Weissman A, Mainor AJ, Orav J, Rosenthal MB, Colla CH, Sequist TD. Cascades of Care After Incidental Findings in a US National Survey of Physicians. JAMA. October 2019
    “Incidental findings on screening and diagnostic tests are common and may prompt cascades of testing and treatment that are of uncertain value. No study to date has examined physician perceptions and experiences of these cascades nationally. The survey findings indicate that almost all respondents had experienced cascades after incidental findings that did not lead to clinically meaningful outcomes yet caused harm to patients and themselves. Policy makers and health care leaders should address cascades after incidental findings as part of efforts to improve health care value and reduce physician burnout.”
  • Patel S, Shariff M, Shah J, Campbell N, Gor S, Alrefaee A, Khan I, Mushtaq A, Bakr M, Kaunzinger C, Caron M, Frank E, Hossain MA, Carpenter K, Kountz D, Sable K, Vachharajani T, Asif A, Kaplan A. Resident Led Tele-intervention Program: An Impactful Strategy to Reduce Inappropriate Use. American Journal of Internal Medicine. October 2019
    “Multiple studies have documented an inappropriate and excessive use of telemetry during hospitalization. In this IRB approved study, we report the impact of a focused residents led intervention program on reducing inappropriate telemetry use. Overall, there were 9 less tele patients/day during the post intervention phase occupying a high cost tele-bed in the intervention group ($8,141 saved/day) and there were 810 less tele patients for the duration of the study. A resident led intervention program reduced inappropriate use of telemetry and minimized costs without compromising patient safety.”

Media Coverage

  • Germany: Too many medical procedures are ‘unnecessary.’ Deutsche Welle. November 2019
    “Far too often, patients in Germany undergo avoidable medical treatments and surgeries, according to a study by the Bertelsmann Foundation released Tuesday. The researchers said unnecessary drug prescriptions, tests and operations caused harm and extra stress to patients, and wasted valuable resources that could be urgently needed elsewhere.”
  • Medical groups differ on when to start colon and rectal cancer screening. Here’s why. CNN. November 2019
    “Conflicting recommendations on when and how average-risk adults should get screened for colon and rectal cancer could leave you confused — but new guidance aims to make sense of it all.”
  •  Nursing Homes Are Pushing the Dying Into Pricey Rehab. Bloomberg. October 2019
    “Nursing home residents are increasingly spending time in rehabilitation treatment during the last days of their lives, subjected to potentially unnecessary therapy that reaps significant financial benefits for cash-strapped facilities, a study shows.”