September 15, 2016
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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Several groups of researchers have found that at least a third of all health care expenditures in the United States are wasted. Now, a study from the University of California, San Francisco, reported in CaliforniaHealthline, finds that an astonishing part of that waste at UCSF—about $1,000 per surgery—may account for medical supplies that are not used and discarded. Observations of 14 surgeons who performed 58 neurosurgeries found that supplies such as sponges, gloves and sterile surgical blue towels were the most common supplies that were tossed unopened. Surgifoam, a sponge used to stop bleeding, was among the most expensive items at close to $4,000. Yearly waste of supplies in the neurosurgery department alone at UCSF is projected at close to $3 million. Michael Lawton, MD, one of the surgeons who was part of the study, speculated that the waste generated from surgeries he performs each year probably amounts to close to $400,000. Environmental impact from waste was another concern. The authors recommend removing unnecessary supplies from surgical request lists and clarifying which supplies could be opened at the start of a procedure. Only unopened supplies can be reused. “These savings could translate into teaching and research opportunities and also allow more patients to come in for treatment,” Lawton asserted. If UCSF and the other 5,000-plus hospitals in the U.S. stopped wasting resources, how much lower would the nation’s medical bill be?
Publication bias in academic journals is a disturbing consequence of industry influence in clinical trials. According to a study from the BMJ and another from the Annals of Internal Medicine, clinical trials that received industry funding were less likely to be published in academic journals than trials not funded by industry – and when they were published, were more likely to report positive outcomes. However, a new initiative called OpenTrialsFDA is bringing to light results from another less-biased source of clinical data—the FDA’s Drug Approval Packages (DAPs). DAPs not only include results from unpublished clinical drug trials, but also reject trials that switch their analytical methods in the middle of the study, reducing bias from “HARKing” (Hypothesizing After the Results are Known). The difference is staggering. For example, a New England Journal of Medicine study comparing clinical trials of antidepressants found that 94% of studies published in journals had positive results, but in the DAP studies, only 51% of studies had positive results (see the astonishing graphic from the article). OpenTrialsFDA will be a valuable tool for transparency in clinical trials, making DAPs more easily accessible by linking DAP results to published clinical trial data and creating a searchable interface. However, until we get industry money out of medical studies, the validity of medical research will remain unreliable.
Thirty-one days to go, and we can’t wait! Right Care Action Week is almost here. Hundreds of people around the nation will be participating in activities that demonstrate what right care should be. Our theme this year is Listening. That’s what Maia Dorsett, MD, will be doing when she asks her patients in the emergency department what their biggest worry is. Last year during RCAW Dorsett and colleague Alica Oberle, MD conducted the same activity. They passed out index cards to patients and asked them to write down what their biggest worry. The answers surprised them; many patient concerns weren’t specifically medical, but instead involved social supports and safety. The doctors’ goals then and this year are to improve overall communications with patients and decrease ‘preference misdiagnosis’—a failure to elicit patient preferences about treatment. “We have the pressure [in the ER] to see more and more patients, and there is a risk of depersonalization—charging through your day—which decreases the meaning of our work. Over the long term, you get to enjoy your job less,” she said. “This effort renewed meaning in our work” and they believe, improved care. Read the blog about Dorsett here. And sign up for RCAW, if you haven’t already.
Vikas Saini, MD, president of the Lown Institute, was interviewed Monday for the Conversation on Health Care program, which is syndicated nationally on the ReachMD Channel on iHeartRadio and TuneIn. It’s direct-subscribed to more than a million individuals in the medical profession. Hear him here ,starting at 4:19 on the time bar, discussing Right Care Action Week, the Right Care Alliance Councils, evidence-based medicine and waste in the health care system.
The 2016 Patient-Centered Outcomes Research Institute Annual Meeting will take place November 17-19, 2016 in the greater Washington, D.C. area. Scholarships are available for patients, caregivers, and trainees/graduate students in the health fields to cover the cost of travel, hotel, registration, and other expenses. Application deadline is Friday, September 30. Learn more here.
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