September 2019 Learning Network Resources

Upcoming Webinars and Discussions

Tuesday, October 15 at 4:00PM EST

Join us for the Choosing Wisely Learning Network webinar series, “Supporting Clinical Decision Making,” with speaker Tim Hannon from Healthcare Forward.

Watch a recording of the webinar.

Blogs, Issue Briefs, Opinion Pieces and More…

• Technology gives labs a hand with utilization management. Labpulse. September 2019
  
  “Lab testing is notoriously prone to errors of overuse and underuse, with serious financial and clinical consequences. When word of mouth isn’t enough to change course, machine-learning models and computerized systems for monitoring the use of tests can step in with objective support, new studies show.”

• Couldn’t Be Easier: A Handy Chart for Well-Woman Care. Medscape. September 2019
  
  “Led by the American College of Obstetricians and Gynecologists, WPSI has developed a concise chart which details women’s preventive services for clinicians, regardless of specialty, and for women.”
• Lessons on patient and public engagement from the Choosing Wisely campaigns. BMJ Opinion. September 2019
  
  “Using an evidence based framework, the toolkit provides a diverse set of ways in which patients and the public can be engaged in Choosing Wisely campaigns. The toolkit highlights a range of efforts from national public education to tools that foster improved shared decision-making. The 28 cases can offer more general insights into opportunities and challenges for patient and public engagement in healthcare.”

Journals

• Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2019 Update on Medical Overuse. JAMA Internal Medicine. September 2019
  
  “The findings suggest that many tests are overused, overtreatment is common, and unnecessary care can lead to patient harm. This review of these 2018 findings aims to inform practitioners who wish to reduce overuse and improve patient care.”
   
• Smith-Bindman R, Kwan ML, Marlow EC, Theis MK, Bolch W, Cheng SY, Bowles EJA, Duncan JR, Greenlee RT, Kushi LH, Pole JDP, Rahm AK, Stout NK, Weinmann S, Miglioretti DL. Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000-2016. JAMA. September 2019
  
  “From 2000 to 2016 in 7 US integrated and mixed-model health care systems and in Ontario, rates of CT and MRI use continued to increase among adults, but at a slower pace in more recent years. In children, imaging rates continued to increase except for CT, which stabilized or declined in more recent periods.”
   
• Rubins D, Boxer R, Landman A, Wright A. Effect of default order set settings on telemetry ordering. Journal of the American Medical Informatics Association. JAMIA. September 2019
  
  “We performed a retrospective, controlled, before-after study of patients admitted to a house staff medicine service at an academic medical center examining the effect of changing whether the admission telemetry order was pre-selected or not. Decisions about default selections in electronic health record order sets can have significant consequences on ordering behavior.”
   
• Tseng EK, Mukweji G, Weinerman A, Fuller J, McLeod A, Wong BM, Kuper A, Stroud LS. Choosing Words Wisely – Residents’ Use of Rhetorical Appeals in Conversations About Unnecessary Tests. Academic Medicine. September 2019
  
  “These observations yield insights into how recent emphasis within residency education on appropriate test utilization may manifest when residents put recommendations into practice in conversations with patients. This study’s framework of rational appeals may be helpful in designing communication curricula about unnecessary testing.”
   
• Barry C, Kaufman S, Feinstein D, Kim N, Gandhi S, Nikolic D, Edmonston TB, Bierl C. Optimization of the Order Menu in the Electronic Health Record Facilitates Test Patterns Consistent With Recommendations in the Choosing Wisely Initiative. American Journal of Clinical Pathology. August 2019
  
  “Thyroid and rheumatologic autoimmune testing are areas where evidence-based guidance from specialty organizations and Choosing Wisely support utilizing screening tests for autoimmune and thyroid disorders prior to more specialized testing. Adjustment of the orderable options in the electronic health record (EHR) can influence ordering patterns without requiring manual review or additional effort by the clinician.”

Media Coverage

• Groupon For Medical Scans? Discounted Care Can Have Hidden Costs. NPR. September 2019
  
  “A lot of the deals offered are for preventive scans, she says, providing patients incentives to come in.  But Dr. Andrew Bierhals, a radiology safety expert at Washington University in St. Louis’ Edward Mallinckrodt Institute of Radiology, warns that such deals may be leading patients to get unnecessary initial scans — which can lead to unnecessary tests and radiation.”
• Physician, Regulate Yourself. The New York Times. September 2019
  
  “The growth in the volume of imaging studies is partly a problem of society, driven by the aging of the population, new technology and the rise of chronic diseases. But it is also a problem of doctors’ making, driven by forces such as “defensive” medicine by doctors trying to avoid lawsuits, a reluctance on the part of doctors (and patients) to accept diagnostic uncertainty (thus leading to more tests) and simply poor clinical decisions. No one is better equipped to address these issues than doctors.”
• MRI, CT scan use continues to rise, in spite of health risks. MSN. September 2019
  
  “‘Medical imaging is an important part of health care and contributes to accurate disease diagnosis and treatment, but it also can lead to patient harms such as incidental findings, overdiagnosis, anxiety and radiation exposure that is associated with an increased risk of cancer,’ lead author Rebecca Smith-Bindman, a researcher at the University of California at San Francisco and study lead author, said in a news release.
• How To Teach Future Doctors About Pain In The Midst Of The Opioid Crisis. NPR. September 2019
  
  “You really need to address the whole person,’ says Traci Speed, assistant professor of psychiatry and behavioral sciences at Johns Hopkins. She notes that co-occurring depression or substance use can increase the severity of pain. ‘It’s the chicken and the egg, which one do you treat first? And sometimes, you have to treat both to really get patients to improve.”