[caption id="attachment_16466" align="alignleft" width="224"]
Erika Newton MD, MPH[/caption]
MedicalResearch.com Interview with:
Erika Newton MD, MPH
Department of Emergency Medicine
Stony Brook University Medical Center
Stony Brook, NY
and
Brenda Sirovich MD, MS
Staff Physician Co-Director
Outcomes Group VA Medical Center
White River Junction, VT
Associate Professor of Medicine and of Community and Family Medicine
Geisel School of Medicine at Dartmouth, and
The Dartmouth Institute for Health Policy and Clinical Practice
Division of Trauma Surgery, Department of Surgery
Stony Brook University Medical Center
Stony Brook, New York
Medical Research: What is the background for this study?
Response: Clinical performance measures – quality indicators used to evaluate and motivate health care providers' performance – play a central role right now in efforts to improve quality in U.S. health care. But their potential to influence care on a wide scale has some worried about unintended effects.
In particular, there’s been growing concern that if performance measures focus disproportionately on
underuse of care – that is, measuring whether
enough care is being provided – they risk leading to unexpected consequences. Specifically, if incentives tend to reward clinicians for doing
more without attention to whether they do
too much – this could inadvertently contribute to the problem of excessive care, or overuse.
Medical Research: What are the main findings?
Response: We thought it was important to look at what that balance is – between measures of
underuse and measures of
overuse – in outpatient practice. We looked at 16 major national collections of performance measures and essentially counted measures targeting underuse (‘Did the clinician do enough?’) versus overuse (‘Did the clinician do too much?’).
We found that over 90 percent of 521 outpatient measures targeted underuse, while a mere 7 percent of outpatient measures addressed overuse – in fact nearly half of the collections contained no overuse measures at all.
MedicalResearch.com Interview with:
Philip M.P. Poortmans PhD MD
Head of Department, Radiation Oncology
ESTRO President
Radboud university medical center
The Netherlands
Medical Research: What is the background for this study?
Dr. Poortmans: Based on the former hypothesis that breast cancer sequentially spreads from breast to lymph nodes and from there to distant organs, up to the eighties it was very custom to perform extended radical surgery and to irradiate extensively locoregional for most patients. With the growing interest in systemic treatments to prevent development (= from already present undetectable cancer cells to really visible and threatening metastases) of distant metastases, new information about possible late side effects and our increasing knowledge about the biological behaviour of breast cancer in the eighties and the nineties, the extend of especially locoregional treatment was gradually reduced. For radiation therapy, often the irradiation of the internal mammary lymph nodes was left aside, as this was linked to the delivery of radiation dose to the heart, possibly or probably leading to late side effects. At the start of the study, about half of the radiation oncology departments did include irradiation of the internal mammary lymph nodes in patients with risk factors, while the other half did not. Hereby we had an ideal base for the investigation of the value of treating the non-operated part of the regional lymph nodes.
