Boston, MA—Dr. Lauren Taylor, a general surgery resident at the University of Wisconsin, won this year’s Best Abstract Award at the Lown Institute annual conference, May 5-7 in Boston. This year’s research symposium focused on two main themes: drivers of over-testing and -treatment and shared decision making between doctors and patients.
Dr. Taylor’s research analyzed communication between surgeons and frail, older patients with life-threatening surgical conditions. She found three critical barriers to shared decision making. First, surgeons failed to reveal the life-limiting nature of the patient’s illness. Second, surgeons asked patients to express preferences for particular treatments without asking about their goals, hopes, and fears. And third, surgeons hesitated to make a treatment recommendation, and instead told the patient, “It’s your decision,” effectively abandoning the patient during a crucial moment, rather than sharing the decision.
The Best Student Abstract Award went to Jean Pannikottu, a medical student at Northeast Ohio Medical University, in Rootstown, OH. Ms. Pannikottu’s research focused on the overuse of cancer screenings. Through a literature review, she and colleagues identified 36 articles published between 1998 and 2016 describing the overuse of cancer screening. They found that across all types of cancer screening, the “younger” older patient was significantly at risk for overuse. Abundant access to primary care drove overuse of breast cancer screening; cervical cancer screening overuse was associated with multiple factors, including a lack of agreement on guidelines among physicians. The researchers concluded that better education of clinicians and patients is important to reduce excess screening.
In addition, four abstract slam sessions provided opportunities for the audience to choose their favorite presenters. Researchers had three minutes to present their projects. The Audience Choice Winners included:
Assess Before Rx: The Harmful Overtreatment of Asymptomatic Hypertension, presented by Sara Diana Pasik, an MD candidate at the Icahn School of Medicine at Mount Sinai. She and colleagues used a retrospective review of one-time orders of anti-hypertension (high blood pressure) medication at a large urban hospital to estimate costs, and an anonymous, electronic survey to collect data on attitudes toward treatment of asymptomatic hypertension. They concluded that overtreatment of asymptomatic hypertension is both prevalent and expensive.
Checking the Check Boxes: An Evidence-Based Review of Quality Performance Measures, presented by Dr. Alan Drabkin, section editor for Family Medicine at DyanMedPlus; Courtney Scanlon, medical student at Tufts University School of Medicine, and Dr. Ron Adler, professor of family medicine UMass Medical School. Using evidence-based criteria, the team examined 65 Primary Care outpatient quality measures included in Medicare Merit-Based Incentive Payment System for 2017. They found that about two thirds of commonly used quality measures have inadequate patient-oriented evidence to support their use or lack specificity for their implementation. Compliance with inappropriate quality measures, the researchers suggest, can lead to unnecessary medical services that can harm to patients, waste resources, and get in the way of delivering the right care. The research team is creating a searchable tool designed to assist providers in minimizing overuse.
Benzodiazepine deprescription in at-risk in-patients: an MUHC pilot study, presented by Dr. Marnie Wilson, an internal medicine resident at McGill University, Montreal. Researchers were concerned that older adults admitted to the hospital are often at risk for adverse reactions to drugs because of “polypharmacy.” Among the potentially harmful medications commonly overprescribed to elderly patients are benzodiazepine sedatives, often prescribed for sleep. The researchers introduced EMPOWER, a patient-directed educational pamphlet, to patients over age 60 admitted to their clinical teaching units. About two-thirds of the patients who participated remained off their sedative at 30-days post discharge, and there were no reported adverse impacts on sleep. Researchers suggest that this type of educational intervention can be successful, despite the complexity of elderly patient’s illnesses.
Feasibility of initiating end of life care in the emergency department, presented by Dr. Christina Creel-Bulos, emergency medicine resident at Washington University in St. Louis, MO. In this study, researchers looked at trends in end-of-life care among dying patients admitted to the emergency department (ED). Using P-CaRES, a palliative care screening tool, they found in a retrospective study of over 300 patients that 60 percent were appropriate candidates for palliative care. Of those meeting the P-CaRES criteria, 54 percent died in the ED. Of the admitted patients, 79 percent went to an ICU; 66 percent of admitted patients were subsequently transitioned to comfort care after an in-patient discussion regarding goals of care. Researchers suggest emergency rooms need to incorporate palliative care for seriously ill patients who may be near the end of life.
The 5th annual Lown Institute conference brought together 250 clinicians, researchers, medical students, policymakers, patients, and community activists determined to improve the American health care system. The three-day conference included a research symposium exploring drivers of overuse, underuse and obstacles to patient-centered care; an examination of the corruption and harm that comes from for-profit companies capturing health care and regulatory institutions; and the national convention for the Right Care Alliance.
Additional research abstracts can be viewed here. http://programme.exordo.com/lown2017/
About the Lown Institute: Founded by world-renowned cardiologist and humanitarian Bernard Lown, the Lown Institute is exposing the failures of the U.S. health care system and advancing a vision that supports universal access to cost-effective, patient-centered care.
The conference is generously supported by the Gordon and Betty Moore Foundation, California Healthcare Foundation, Kaiser Permanente, and others. Special thanks to the platinum level sponsor, Robert Wood Johnson Foundation, for its continuing support. The views expressed at the conference do not necessarily reflect the views of funders.
For further information, contact:
Karen Kahn, Karenkahn33@outlook.com,