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Critical and honest conversations: the evidence behind the "Choosing Wisely" campaign recommendations by the American Society of Nephrology.
Williams AW, Dwyer AC, Eddy AA, Fink JC, Jaber BL, Linas SL, Michael B, O'Hare AM, Schaefer HM, Shaffer RN, Trachtman H, Weiner DE, Falk AR, American Society of Nephrology Quality, and Patient Safety Task Force
(2012) Clin J Am Soc Nephrol 7: 1664-72
MeSH Terms: Anti-Inflammatory Agents, Non-Steroidal, Catheterization, Central Venous, Cost Savings, Cost-Benefit Analysis, Evidence-Based Medicine, Guideline Adherence, Health Care Costs, Health Promotion, Health Services Misuse, Hematinics, Humans, Mass Screening, Nephrology, Patient Safety, Physician-Patient Relations, Practice Guidelines as Topic, Professional-Family Relations, Program Development, Quality Indicators, Health Care, Renal Dialysis, Renal Insufficiency, Chronic, Societies, Medical, United States
Show Abstract · Added February 25, 2014
Estimates suggest that one third of United States health care spending results from overuse or misuse of tests, procedures, and therapies. The American Board of Internal Medicine Foundation, in partnership with Consumer Reports, initiated the "Choosing Wisely" campaign to identify areas in patient care and resource use most open to improvement. Nine subspecialty organizations joined the campaign; each organization identified five tests, procedures, or therapies that are overused, are misused, or could potentially lead to harm or unnecessary health care spending. Each of the American Society of Nephrology's (ASN's) 10 advisory groups submitted recommendations for inclusion. The ASN Quality and Patient Safety Task Force selected five recommendations based on relevance and importance to individuals with kidney disease.Recommendations selected were: (1) Do not perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms; (2) do not administer erythropoiesis-stimulating agents to CKD patients with hemoglobin levels ≥10 g/dl without symptoms of anemia; (3) avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure, or CKD of all causes, including diabetes; (4) do not place peripherally inserted central catheters in stage 3-5 CKD patients without consulting nephrology; (5) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.These five recommendations and supporting evidence give providers information to facilitate prudent care decisions and empower patients to actively participate in critical, honest conversations about their care, potentially reducing unnecessary health care spending and preventing harm.
0 Communities
1 Members
0 Resources
23 MeSH Terms
Underuse of invasive procedures among Medicaid patients with acute myocardial infarction.
Philbin EF, McCullough PA, DiSalvo TG, Dec GW, Jenkins PL, Weaver WD
(2001) Am J Public Health 91: 1082-8
MeSH Terms: Angioplasty, Balloon, Coronary, Cardiac Catheterization, Comorbidity, Coronary Artery Bypass, Female, Health Services Misuse, Health Services Research, Hospital Charges, Hospital Mortality, Humans, Income, Insurance, Health, Length of Stay, Male, Medicaid, Middle Aged, Myocardial Infarction, New York, Patient Discharge, Patient Readmission, Practice Patterns, Physicians', Retrospective Studies, Socioeconomic Factors
Show Abstract · Added May 27, 2014
OBJECTIVES - The purpose of this study was to determine whether underuse of cardiac procedures among Medicaid patients with acute myocardial infarction is explained by or is independent of fundamental differences in age, race, or sex distribution; income, coexistent illness; or location of care.
METHODS - Administrative data from 226 hospitals in New York were examined for 11,579 individuals hospitalized with a primary diagnosis of acute myocardial infarction. Use of various cardiac procedures was compared among Medicaid patients and patients with other forms of insurance.
RESULTS - Medicaid patients were older, were more frequently African American and female, and had lower median household incomes. They also had a higher prevalence of hypertension, diabetes, lung disease, renal disease, and peripheral vascular disease. After adjustment for these and other factors, Medicaid patients were less likely to undergo cardiac catheterization, percutaneous transluminal coronary angioplasty, and any revascularization procedure.
CONCLUSIONS - Factors other than age, race, sex, income, coexistent illness, and location of care account for lower use of invasive procedures among Medicaid patients. The influence of Medicaid insurance on medical practice and process of care deserves investigation.
0 Communities
1 Members
0 Resources
23 MeSH Terms