May 2020 Learning Network Resources

May is National Asthma and Allergy Awareness Month. Check out the Choosing Wisely Clinician Lists – Allergy & Immunology.

Blogs, Issue Briefs, Opinion Pieces and More…

  • Guidelines on Neuroimaging for Migraine. Physician’s Weekly. May 2020
    “Determining when and how to use neuroimaging for migraine is an important issue that physicians face when seeing the 40 million Americans with migraine. Neuroimaging for suspected migraine is used for many reasons, including exclusion of secondary conditions that mimic migraine. Other reasons include medicolegal issues, busy practice conditions in which tests are ordered as a shortcut, providing neuroimaging to appease patient requests, and addressing concerns and expectations of referring clinicians.”
  • Pandemic effect: All other health care visits can wait. MDedge. May 2020
    “A majority of adults are reluctant to visit health care providers unless the visit is related to COVID-19, according to survey conducted at the end of April.”
  • Reduced cancer screenings in Covid-19. Lown Institute. May 2020
    “The authors of the EPIC report make it clear what is at stake–lives lost due to reduced screening. However, it is very likely this number is overestimated, given the high rates of inappropriate screening in the real world, and the potential negative effects of screening on overall mortality. While the true impact of the sudden halt in screening due to Covid-19 remains unknown, we have the opportunity to find out in the future. Such a drastic change in screening is unusual, so we should track the results of this historical experiment to better understand the actual health effects–both beneficial and harmful–of cancer screening.”
  • Soong C, Cho HJ, Shojania KG. Choosing quality problems wisely: identifying improvements worth developing and sustaining. BMJ Quality & Safety. April 2020
    “In this issue of BMJ Quality and Safety, Ambasta and colleagues examined the impact of a social comparison and education intervention on routine blood test utilization at a single academic medical centre. Trainees and attending physicians each received their own performance feedback in comparison with a group aggregate. Compared with controls, the intervention groups ordered fewer routine laboratory tests (incidence rate ratio 0.89; 95% CI 0.79 to 1.00; p=0.048) with an associated cost savings of $68 877 in Canadian dollars (p=0.020).”

Journals

  • Prachand, VN. Medically Necessary, Time-Sensitive Procedures: Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. American College of Surgeons. April 2020
    “Hospitals have severely curtailed the performance of nonurgent surgical procedures in anticipation of the need to redeploy healthcare resources to meet the projected massive medical needs of patients with coronavirus disease 2019 (COVID-19). Surgical treatment of non-COVID-19 related disease during this period, however, still remains necessary. The decision to proceed with medically necessary, time-sensitive (MeNTS) procedures in the setting of the COVID-19 pandemic requires incorporation of factors (resource limitations, COVID-19 transmission risk to providers and patients) heretofore not overtly considered by surgeons in the already complicated processes of clinical judgment and shared decision-making. We describe a scoring system that systematically integrates these factors to facilitate decision-making and triage for MeNTS procedures, and appropriately weighs individual patient risks with the ethical necessity of optimizing public health concerns. This approach is applicable across a broad range of hospital settings (academic and community, urban and rural) in the midst of the pandemic and may be able to inform case triage as operating room capacity resumes once the acute phase of the pandemic subsides.”
  • Bonafide CP. Prevalence of Continuous Pulse Oximetry Monitoring in Hospitalized Children With Bronchiolitis Not Requiring Supplemental Oxygen. JAMA. April 2020
    “In a convenience sample of children hospitalized with bronchiolitis who were not receiving active supplemental oxygen administration, monitoring with continuous pulse oximetry was frequent and varied widely among hospitals. Because of the apparent absence of a guideline- or evidence-based indication for continuous monitoring in this population, this practice may represent overuse.”
  • Siddaiah H, et alt. Preoperative Laboratory Testing: Review of “Choosing Wisely” Guidelines. Best Practice & Research Clinical Anesthesiology. April 2020
    “Healthcare providers, primarily anesthesiologists, should remain cost-conscious when ordering specific laboratory or imaging tests prior to surgery based on available literature. We review the overall evidence and key points from the Choosing Wisely guidelines, identification of potential wasteful practices, possible harms of testing, and key clinical findings associated with preoperative laboratory testing.”
  • Mark TL, Parish WJ, Zarkin GA. Association of Formulary Prior Authorization Policies With Buprenorphine-Naloxone Prescriptions and Hospital and Emergency Department Use Among Medicare Beneficiaries. JAMA Network. April 2020
    “Prior authorization is commonly used for buprenorphine-naloxone because of concerns regarding costs and diversion. These findings suggest that these concerns may be unfounded and that requiring prior authorization before one can access a buprenorphine-naloxone product may be more harmful than beneficial.”
  • Clark SD, Reuland DS, Enyioha C, Jonas DE. Assessment of Lung Cancer Screening Program Websites. JAMA Internal Medicine. April 2020
    “Information on public-facing websites of US lung cancer screening programs appears to lack balance with respect to portrayal of potential benefits and harms of screening. Important harms, such as overdiagnosis, were commonly ignored in the sites evaluated, and most of the centers did not explicitly guide individuals toward a guideline-recommended, shared decision-making discussion of harms and benefits.”
  • Gupta A, et alt. Physician Practice Variability in the Use of Extended-Fraction Radiation Therapy for Bone Metastases: Are We Choosing Wisely? JCO Oncology Practice. April 2020
    “Routine use of extended-fraction (> 10 fractions) radiation therapy (RT) for palliation of bone metastases is recognized as a low-value intervention by the American Society for Radiation Oncology. We examined contemporary practice patterns of, and physician characteristics associated with extended-fraction RT use. In this study, almost one fourth of patients received extended-fraction RT, and one third of physicians had an extended-fraction RT use rate of > 30%. Personalized feedback of performance data, clinical pathways and peer review, and updated reimbursement models are potential mechanisms to address this low-value care.”
  • Schrag D, Hershman DL, Basch E. Oncology Practice During the COVID-19 Pandemic. JAMA. April 2020
    “In the space of a month, approaches and accepted norms of cancer care delivery have been transformed of necessity. Most of these changes would not have occurred without the pandemic. Although the immediate priority is to save lives, in the aftermath and recovery phase, evaluating the effects of COVID-19 on cancer mortality will be a priority. Planning for resuming cancer treatment and screening to mitigate harms is already underway. It is also likely that some changes provoked by the crisis will permanently transform how to treat cancer, in some cases perhaps for the benefit of both patients and their physicians.”

Media Coverage

  • Column: An opportunity to reimagine health care after COVID-19. Quad City Times. May 2020
    “Fourth, the healthcare system will reassess low-value procedures and tests. The U.S. healthcare system spends more than $200 billion on low-value healthcare every year.”
  • How To Get The Most Out Of Your Virtual Medical Appointment. NPR. April 2020
    “It may be frustrating to be told you’ll have to wait for an in-person appointment, but please know that when we say that, it’s done with your health in mind. I certainly miss seeing my patients in person. Telemedicine has plenty of limitations. But I also hope that we doctors can learn from this experience, and start using technology, in some cases, to offer our patients more convenient care. Especially now, when so much of daily life has been upended, “it’s gratifying to be able to offer this additional service to our patients,’ LeRoy says. ‘We can interact with them. They feel connected, and not marginalized or forgotten.’”