References

Annotated lists of references for projects

Acid Suppression Therapy – summary of literature for indications and treatment courses, to be used for medication review during hospitalization. If indications not met or indicated course complete, consider discontinuation and communicate this with outpatient team.

Chest x-rays in the ICUsupport for a symptom-based approach

Background Articles About High-Value Care

First, Do No (Financial) Harm – An important editorial that describes the concept of financial harm and offers a screening tool to assess patients’ vulnerability to this potential side effect of treatment.

Defines High-Value Care and gives examples and a framework for evaluating interventions.

Article proposing cost-consciousness and stewardship as core competencies for practicing physicians.

Video: Atul Gawande hosts a round table discussion about avoiding low-value care.

Article illustrating the difficulty of deadoption of an ineffective clinical practice, once that practice is established.

Potential Targets, and Articles Supporting Them

Cardiac Enzyme Reduction:  Evidence-based use of cardiac enzymes, recommending the elimination of the CK-MB test and troponin-monitoring for 24 hours after symptom onset, only.

Folate Reduction: Folate should no longer be considered part of routine anemia work-up.

Daily AM Lab Reduction: Current Choosing Wisely, Society of Hospitalist Medicine for Adults discourages the use of daily lab monitoring during clinical stability.  Vanderbilt University has had success at reducing this practice.

“Nebs No More at 24:”  A project from UCSF, which notes clinical equivalence of nebulizer and supervised metered-dose-inhaler therapy in the hospital, with the latter often allowing for patient education and lower cost. (see also, below)

How to Form a High-Value Care Committee

Article describing efforts at UCSF to create a high-value care committee.

Teaching and Modeling High-Value Care to Trainees

An article with a table of 37 clinical examples of low-value testing.

A commentary responding to the above article, which notes 5 questions that should be asked before ordering a test.

An editorial describing strategies for modeling high-value care on an inpatient teaching service.

An article describing 20 strategies for teaching value within a residency program.

An editorial listing four questions that attendings can challenge trainees with, when a diagnostic test is suggested.