Author Interviews, Cost of Health Care, JAMA / 28.07.2019
Reducing Unnecessary Testing Without Harming Patient Outcomes
MedicalResearch.com Interview with:
Renuka S Bindraban, MD and
Prabath W. B. Nanayakkara, MD, PhD
Section of Acute Medicine
Department of Internal Medicine
Amsterdam Public Health Research Institute
Amsterdam UMC Vrije Universiteit Amsterdam,
Amsterdam, the Netherland
MedicalResearch.com: What is the background for this study?
Response: It is well known that a significant portion of healthcare activities is considered of low-value. Eliminating such low-value care is often targeted in efforts to both contain rapidly increasing healthcare costs as well as maintain high-quality care.
In this context, our study focused on reducing unnecessary laboratory testing. In 2008, our study group performed a multifaceted intervention aimed at reducing unnecessary diagnostic testing at the Internal Medicine department of the Amsterdam University Medical Center, location Vrije Universiteit (VU).
In the ‘Reduction of Unnecessary Diagnostics Through Attitude Change of the Caregivers’, we implemented this successful intervention in the Internal Medicine departments of four large teaching hospitals in the Netherlands. The intervention included creating awareness through education and feedback, intensified supervision of residents, and changes in order entry systems.
Renuka S Bindraban, MD and
Prabath W. B. Nanayakkara, MD, PhD
Section of Acute Medicine
Department of Internal Medicine
Amsterdam Public Health Research Institute
Amsterdam UMC Vrije Universiteit Amsterdam,
Amsterdam, the Netherland
MedicalResearch.com: What is the background for this study?
Response: It is well known that a significant portion of healthcare activities is considered of low-value. Eliminating such low-value care is often targeted in efforts to both contain rapidly increasing healthcare costs as well as maintain high-quality care.
In this context, our study focused on reducing unnecessary laboratory testing. In 2008, our study group performed a multifaceted intervention aimed at reducing unnecessary diagnostic testing at the Internal Medicine department of the Amsterdam University Medical Center, location Vrije Universiteit (VU).
In the ‘Reduction of Unnecessary Diagnostics Through Attitude Change of the Caregivers’, we implemented this successful intervention in the Internal Medicine departments of four large teaching hospitals in the Netherlands. The intervention included creating awareness through education and feedback, intensified supervision of residents, and changes in order entry systems.
Dr. Phelan[/caption]
Dermot Phelan, MD, PhD
Director of the Sports Cardiology Center
Cleveland Clinic in Cleveland, Ohio
MedicalResearch.com: What is the background for this study?
Response: It is well recognized that long-term elite endurance athletes are at higher risk of atrial fibrillation. We wished to evaluate whether this held true for primarily strength-type athletes. We had the opportunity to screen almost 500 former NFL athletes. It became clear that we were seeing more atrial fibrillation than one would expect during the screenings.
Dr. Wee[/caption]
Christina C. Wee, MD, MPH
Associate Professor of Medicine
Harvard Medical School
Director , Obesity Research Program Division of General Medicine
Beth Israel Deaconess Medical Center (BIDMC)
Associate Program Director, Internal Medicine Program, BIDMC
Deputy Editor of the Annals of Internal Medicine
MedicalResearch.com: What is the background for this study?
Response: New research is showing that for many people without diagnosed heart disease, the risk of bleeding may outweigh the benefits of taking a daily aspirin particularly in adults over 70 years of age. The American Heart Association and the American College of Cardiology recently updated their guidelines and now explicitly recommend against aspirin use among those over the age of 70 who do not have existing heart disease or stroke.
Our study found that in 2017, a quarter of adults aged 40 years or older without cardiovascular disease – approximately 29 million people – reported taking daily aspirin for prevention of heart disease. Of these, some 6.6. million people did so without a physician's recommendation.
Frank Qian[/caption]
Frank Qian, MPH
Department of Nutrition
Harvard T. H. Chan School of Public Health
Boston, Massachusetts
MedicalResearch.com: What is the background for this study?
Response: Plant-based diets have really grown in popularity in the last several years, particularly among the younger generation in the United States, many of whom are adopting a plant-based or vegetarian/vegan diet. However, the quality of such a diet can vary drastically. While many prior studies have demonstrated beneficial associations for risk of type 2 diabetes with healthful plant-based foods such as fruits, vegetables, nuts/seeds, whole grains, and legumes, the opposite is true for less healthful plant-based foods such as potatoes and refined grains such as white rice. In addition, some animal-based foods, such as dairy and fish, have shown protective associations against the development of type 2 diabetes, so strict vegetarian diets which exclude these foods may miss out on the potential benefits.
Given these divergent findings, we sought to pool all the available data from prior cohort studies to analyze whether the overall association of a diet which emphasizes plant-based foods (both healthful and unhealthful) are related to risk of type 2 diabetes.
Mr Jue Sheng Ong, PhD Student
QIMR Berghofer’s Statistical Genetics Group
MedicalResearch.com: What is the background for this study? Response: Previous findings have shown conflicting results on whether coffee is associated with cancer risk.
To evaluate whether there’s any evidence for a causal relationship between coffee and cancer outcomes, we performed two types of association analyses using data from the half a million participants in the UK.
