Academia

Creating Value through Crowdsourcing & Finding “Value” in the New Year

Earlier this month, I took a day trip to the University of Michigan Frankel Cardiovascular Center for their inaugural value challenge. Little did I know that when I arrived, I would be part of an all-star judging team that would be giving away $100,000 (a.k.a. real money) complete with a “big check”, a la Publisher’s Clearing House, to the best idea to improve value! Given that I do not see patients on our cardiology service, I was starting to wonder if I was in over my head. The good news is that value was defined quite broadly by different stakeholders; I was able to follow along, even though I wasn’t up to date with the latest in intra-aortic balloon pumps. We heard from 5 finalists. Interestingly, 3 of the ideas centered on specialized teams to improve care coordination for specific conditions such as atrial fibrillation, pulmonary embolism, or cardiogenic shock. While…

Male Versus Female Hospitalists

If you have paid attention to the news, you picked up the study out in JAMA concerning how male versus female physicians deliver inpatient care.  Not just any inpatient docs, though, but hospitalists. The investigators were meticulous in their analysis of over a million Medicare beneficiaries and looked at readmit and mortality rates.  They examined various diagnoses and adjusted for the usual doctor and hospital characteristics. Across the board, males took a drubbing and the NNT for both outcomes of interest hovered around 200 (0.5% absolute difference). Ashish Jha, one of the investigators and a leader in the study of hospital quality and safety (who really needs to speak at an SHM annual, incidentally) goes into more depth over at his blog: (more…)

How I Realized QI Could Be a Dirty Word

With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to often mention, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?” Recently, I read a paper that helped me realize I had been swimming in a different lake from most of the “real world” in medicine. I trained and then spent the first 4 years of my post-residency career at UCSF, where quality improvement (QI) was well established and celebrated. Sure, I suppose there were some eye rolls from a few surgeons, or…

Next on #JHMChat: Ideas from Residents to Root Out Routine Labs

While the saying goes, “you can’t teach an old dog new tricks”, I think we all assume you can teach a new dog new tricks… or at least all of us in medical education believe this! However, new research in the Journal of Hospital Medicine highlights that maybe the old dog is the key to the puzzle after all. In the case of routine labs, a practice that has already been called into question by the Society of Hospital Medicine’s Choosing Wisely list, the majority of medicine and surgery residents at University of Pennsylvania admitted that they engaged in unnecessary ordering of inpatient labs, with over a third of them occurring on a daily basis! Why is this so hard to change? Not surprisingly, one of the key culprits was it was hard-to-break habit. However, several of the top reasons were also related to the “old dog”, also known as…

Want To Keep Your Patient Out of the Hospital? Here Is Your Crystal Ball.

If I told you I planned to close a quarter of the country's cardiac catheterization labs, how would you react? You would probably express outrage and accuse me of mismanagement of our entire health system.  And that is to say nothing of all the harm that would come to patients.  But as docs, we reason in a prejudiced fashion.  We do medicine.  We write prescriptions.  We look at blood test results.  That is our profession after all.  It is how we extend lives and improve people’s well-being.  If we can measure, see, or manipulate a variable, anything attached to it must have value.  We have been trained to infer from that ethos with everything else taking a back seat. However, what if I then said I would reinvest every dime saved from those closures above and direct them towards all the people in our communities.  How many more lives might…
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