Acid Suppression Therapy - summary of literature for indications and treatment courses, to be used for medication review during hospitalization. If indications not met or indicated course complete, consider discontinuation and communicate this with outpatient team.
Annotated lists of references for projects
Chest x-rays in the ICU - support for
a symptom-based approach
Background Articles About High-Value Care
First, Do No (Financial) Harm
An important editorial that describes the concept of financial harm and offers a screening tool to assess patients' vulnerability to this potential side effect of treatment.
Moriates C, Shah NT, Arora VM. First, Do No (Financial) Harm. JAMA. 2013;310(6):577-578.
Defines High-Value Care and gives examples and a framework for evaluating interventions.
Owens DK, Qaseem A, Chou R, Shekelle P, for the Clinical Guidelines Committee of the American College of Physicians. High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions. Ann Intern Med. 2011;154:174-180.
Article proposing cost-consciousness and stewardship as core competencies for practicing physicians.
Weinberger SE. Providing High-Value, Cost-Conscious Care: A Critical Seventh General Competency for Physicians. Ann Intern Med. 2011;155:386-388.
|Video: Atul Gawande hosts a round table discussion about avoiding low-value care. || Video: Avoiding Low-Value Care. N Engl J Med 2014; 370:e21 April 3, 2014 Atul Gawande, round table discussion with Carrie Colla, Dartmouth Institute of Health Policy and Clinical Practice, Dr. Scott Halpern University of Pennsylvania; and Bruce Landon Harvard Medical School. Transcript|
| Article illustrating the difficulty of deadoption of an ineffective clinical practice, once that practice is established.|| Niven, DJ et al. Effect of Published Scientific Evidence on Glycemic Control in Adult Intensive Care Units. JAMA Intern Med. 2015;175(5):801-809. doi:10.1001/jamainternmed.2015.0157.|
Potential Targets, and Articles Supporting Them
Cardiac Enzyme Reduction: Evidence-based use of cardiac enzymes, recommending the elimination of the CK-MB test and troponin-monitoring for 24 hours after symptom onset, only.
Larochelle MR, Knight AM, Pantle H, Riedel S, Trost JC. Reducing excess cardiac biomarker testing at an academic medical center Journal of General Internal Medicine. 2014
Folate Reduction: Folate should no longer be considered part of routine anemia work-up.
Theisen-Toupal J, Horowitz G, Breu A. Low yield of outpatient serum folate testing JAMA Internal Medicine. 2014
Daily AM Lab Reduction: Current Choosing Wisely, Society of Hospitalist Medicine for Adults discourages the use of daily lab monitoring during clinical stability. Vanderbilt University has had success at reducing this practice.
"Nebs No More at 24:" A project from UCSF, which notes clinical equivalence of nebulizer and supervised metered-dose-inhaler therapy in the hospital, with the latter often allowing for patient education and lower cost. (see also, below)
Moriates C, Mourad M, Novelero M, Wachter RM. Development of a hospital-based program focused on improving healthcare value Journal of Hospital Medicine. 2014
Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD Journal of General Internal Medicine. 2011; 2011; 26:635-642.
How to Form a High-Value Care Committee
Teaching and Modeling High-Value Care to Trainees
|An article with a table of 37 clinical examples of low-value testing. ||Qaseem A, Alguire P, Dallas P, Feinberg LE, Fitzgerald FT, Horwitch C, et al. Appropriate Use of Screening and Diagnostic Tests to Foster High-Value, Cost-Conscious Care. Ann Intern Med. 2012;156:147-149.|
|A commentary responding to the above article, which notes 5 questions that should be asked before ordering a test. ||Laine C. High-value testing begins with a few simple questions. Ann Intern Med. 2012;156:162-163.|
| An editorial describing strategies for modeling high-value care on an inpatient teaching service. || Dhaliwal G. Bringing High-Value Care to the Inpatient Teaching Service. JAMA Intern Med. 2014;174(7):1021-1022. |
| An article describing 20 strategies for teaching value within a residency program. ||Patel MS, Davis MM, Lypson ML. The VALUE framework: Training residents to provide value-based care for their patients J Gen Intern Med. 2012; 27:1210-1214|
| An editorial listing four questions that attendings can challenge trainees with, when a diagnostic test is suggested. ||Weinberger SE. Educating trainees about appropriate and cost-conscious diagnostic testing Acad Med. 2011; 86:1352|