September 2020 Learning Network Resources

Blogs, Issue Briefs, Opinion Pieces and More…

  • Building A Better Health Care System Post-Covid-19: Steps for Reducing Low-Value and Wasteful Care. NEJM Catalyst. August 2020
    “The range of actions we outline herein are certainly not exhaustive, but represent critical steps that a range of stakeholders can take in the coming months. Now more than ever, we need to allocate our limited health care resources towards services that produce better outcomes, at lower costs, and that align with patient values and preferences. This ‘new normal’ can help build a more flexible, innovative system for achieving these goals.”
  • Hyman P, et alt. The Disappearance of the Primary Care Physical Examination—Losing Touch. JAMA Internal Medicine. August 2020
    “In the past 10 years, with the emergence of the electronic health records and team-based care, we primary care physicians have found ourselves on unsure footing with our identity and way of practicing frequently shifting and disrupted. I have no doubt that when the dust settles from the coronavirus disease 2019 pandemic, things will once again be changed, including a reexamination of the role of the in-office physical examination. This examination, in its current form, may be left behind. As Michael Rothberg writes in a recent JAMA piece, some physical examinations, in our current health care environment, can have unintended costly and risky consequences, leading to “invasive and potentially life-threatening tests.”4(p1683) While I am sympathetic to this rationale and recognize the benefits of telehealth, I struggle to find equipoise. In attempting to keep patients at a distance, I am losing touch with a part of my professional identity.”

 

Journals

  • Santos MT, et alt. Assessing Student Competencies in Antibiotic Stewardship and Patient Counseling. Family Medicine. 2020
    “Antibiotic misuse contributes to antibiotic resistance and is a growing public health threat in the United States and globally. Professional medical societies promote antibiotic stewardship education for medical students, ideally before inappropriate practice habits form. To our knowledge, no tools exist to assess medical student competency in antibiotic stewardship and the communication skills necessary to engage patients in this endeavor. The aim of this study was to develop a novel instrument to measure medical students’ communication skills and competency in antibiotic stewardship and patient counseling. Similar results at both schools supported external validity. The instrument performed reliably at both institutions under different examination conditions, providing evidence for the validity and utility of this instrument in assessing medical students’ skills related to antibiotic stewardship.”

  • Belli HM, et alt. Implementation of a Behavioral Economics Electronic Health Record (BE-EHR) Module to Reduce Overtreatment of Diabetes in Older Adults. J Gen Intern Med. September 2020
    “The BE-EHR module shows promise for promoting the AGS CW guideline and improving diabetes management in older adults. A randomized controlled trial will commence to test the effectiveness of the intervention across 66 NYULH clinics.”

  • What to Do and What Not to Do in the Management of Opioid-Induced Constipation: A Choosing Wisely Report. Pain and Therapy. September 2020
    “In conclusion, the current state of OIC diagnosis and management remains inadequate but is bolstered by apparent physician interest in improving the standard of care in patients who take a long-term opioid. Here we propose a simple set of corrective actions that can assist physicians across a variety of disciplines in standardizing OIC detection and enacting timely, evidence-based treatment.”

  • Kerr EA, et alt. Identifying Recommendations for Stopping or Scaling Back Unnecessary Routine Services in Primary Care. JAMA Internal Medicine. September 2020
    “In this study, a total of 178 unique opportunities to deintensify routine primary care services were identified, and 37 of these were validated as high-priority deintensification recommendations. To date, this is the first study to develop a model for identifying, specifying, and validating deintensification recommendations that can be implemented and tracked in clinical practice.”

  • Mullman L, et alt. Improved Outcomes With an Enhanced Recovery Approach to Cesarean Delivery. Obstetrics & Gynecology. September 2020
    “A pre–post design was used to assess changes in opioid use, length of stay, and costs among all patients undergoing cesarean delivery before and after implementation of an evidence-based ERAS pathway for the preoperative, intraoperative, and postoperative management of patients beginning December 2018. An ERAS approach for the cesarean delivery population is associated with improved outcomes including decreases in opioid use, length of stay, and costs.”

  • Shuren J, et alt. Covid-19 Molecular Diagnostic Testing — Lessons Learned. NEJM. September 2020
    “Fourth, the clinical community should understand test performance and how to use that information in patient care. Tests should be accompanied by clear, standardized, comprehensible information on performance for clinicians and patients. Training and continuing education can enhance physicians’ understanding of test performance, selection, interpretation, and clinical usefulness. As we continue to address Covid-19, it’s important to reflect on what we’ve learned to better prepare ourselves for current and future epidemics.”

  • Mahtta D, et alt. Evaluation of Aspirin and Statin Therapy Use and Adherence in Patients With Premature Atherosclerotic Cardiovascular Disease. JAMA Network. August 2020
    “In this study, patients with premature or extremely premature ASCVD appeared to be less likely to use aspirin or statins and to adhere to statin therapy. This finding warrants further investigation into premature ASCVD and initiatives, including clinician and patient education, to better understand and mitigate the disparities in medication use and adherence.”

  • Blazin LJ, et alt. Improving Patient Handoffs and Transitions through Adaptation and Implementation of I-PASS Across Multiple Handoff Settings. Pediatric Quality and Safety. August 2020
    “I-PASS is adaptable to many handoff settings, which expands its potential to improve patient safety. Clinicians reported reductions in errors and improvements in handoff performance. We identified broad institutional support, customized written handoff documents, and peer observations with feedback as crucial factors in sustaining I-PASS usage.”

 

Media Coverage

  • Why we need to reduce low-value carotid imaging. Lown Institute. September 2020
    “While carotid (neck) artery imaging can be very helpful to evaluate patients who have had a stroke or mini-stroke, carotid imaging is commonly used on asymptomatic patients, for whom there is little evidence of benefit.”

  • “Lack of Antigen Test Reporting Leaves Country ‘Blind to the Pandemic.’” Kaiser Health News. September 2020
    “More than 20 states either don’t release or have incomplete data on the rapid antigen tests now considered key to containing the coronavirus, which has sickened more than 6 million Americans. The lapses leave officials and the public in the dark about the true scope of the pandemic as untold numbers of cases go uncounted.”

  • AAP: Choosing Wisely Recs on Pediatric Pulmonology, Sleep Medicine. MPR. September 2020
    “Prior to utilizing medical therapies and practices to manage asthma and sleep disorders in children, pediatricians and families should consider the new guidance from Choosing Wisely, according to the American Academy of Pediatrics (AAP). The list, ‘Five Things Physicians and Patients Should Question,’ was developed by members of the AAP Section on Pediatric Pulmonology and Sleep Medicine.”

  • Low carbon inhalers: Choosing wisely for patients and the environment. The College of Family Physicians of Canada. August 2020
    “A modifiable contributor to healthcare-derived greenhouse gas (GHG) emissions is the use of inhaled therapy for respiratory conditions. Physicians prescribing inhalers may not always consider their environmental impact, making this an important area of intervention that could be scaled up across Canadian primary care.”