Reducing Overprescribing Through Peer Comparison Letters

Antipsychotic agents, such as quetiapine fumarate, are frequently overprescribed for indications not supported by clinical evidence, potentially causing harm.  In this randomized clinical trial, a peer comparison letter randomized across the 5055 highest Medicare prescribers of the antipsychotic quetiapine fumarate reduced prescribing for at least 2 years. Effects were larger than those observed in existing large-scale behavioral interventions, potentially because of the content of the peer comparison letter, which mentioned the potential for a review of prescribing activity.  This indicates that behavioral nudge interventions can raise the quality of prescribing, but research is still needed on how to most precisely target unsafe prescribing behavior.

The full article, entitled "Effect of Peer Comparison Letters for High-Volume Primary Care Prescribers of Quetiapine in Older and Disabled Adults: A Randomized Clinical Trial" can be viewed here.  

Merging Electronic Health Record Data and Genomics for Cardiovascular Research

Electronic health records (EHRs) have assumed a major role in medical practice in the United States.  EHRs also have the potential to accommodate genetic and genomic data in a manner similar to how they handle clinical laboratory data. Including genomic data with the clinical information in EHRs provides the potential to improve our understanding of the underlying mechanisms of health and disease and to improve the overall care of patients. The announcement of the Precision Medicine Initiative by the US government reaffirms the change in patient care on the horizon. In this report, the American Heart Association summarizes the existing landscape and current hurdles of genomic research in cardiovascular disease in the era of the EHR.

The full AHA science advisory can by viewed below

Data Brief: Physician Perspectives on Access to Patient Data

What types of actionable patient intelligence are most important to physicians today? In October 2017, Surescripts commissioned a survey of 300 U.S. physicians to gather insights on their access to and need for patient data. We wanted to understand where they get data, which sources they trust and what data they find most valuable.

Key Findings

• Half of Physicians Say Data Access Could Be Much Better
• The Biggest Data Gap: Medication Adherence
• Price Transparency Aids Prescribing Decisions
• Lack of Patient History Data Impedes Care Coordination

The full data brief can be viewed below

Stem the Tide: Addressing the Opioid Epidemic

Every day, hospitals and health systems see the effects of the nation’s opioid epidemic. According to the Centers for Disease Control and Prevention, more than 33,000 people died from an opioid-related overdose in 2015. That’s more than 90 people a day or approximately four people each hour. There are also financial implications due to increased health care and substance use disorder treatment costs, lost productivity and costs to the criminal justice system, estimated to be $78.5 billion in 2016. Across the U.S., hospitals and health systems are working to address this public health crisis. To help in their efforts, the American Hospital Association developed this toolkit to provide guidance and resources to hospitals and health systems on how to work with patients, clinicians and communities to stem the opioid epidemic. From working on the front lines of the emergency department to connecting patients with treatment and recovery resources in their communities, the nation’s hospitals and health systems are partnering with community organizations and providers to address the opioid epidemic on a daily basis.  Recognizing the multifaceted role of hospitals and health systems, the AHA developed this toolkit with input from a multidisciplinary team, including representatives from nursing, risk management, physician leadership, research and the AHA’s Section for Psychiatric and Substance Abuse Services and Committee on Clinical Leadership. In addition, we vetted the resources with subject matter experts, including psychiatrists specializing in addictions, chief clinical officers and other clinical experts, pain management professionals, and a broad array of stakeholders. This toolkit will be updated regularly to help the field move forward in addressing the opioid epidemic in communities.

The full toolkit can be viewed below.  

Impact of Telemedicine on Mortality, Length of Stay, and Cost Among Patients in Progressive Care Units: Experience From a Large Healthcare System

Although there are many studies about the effects of telemedicine in ICU, currently there are no studies on the effects of telemedicine in progressive care unit settings. Our study showed that TPCU intervention significantly decreased mortality in progressive care unit and hospital and progressive care unit length of stay despite the fact patients in TPCU were older and had higher disease severity, and risk of mortality. Increased postprogressive care unit hospital length of stay and total mean direct costs inclusive of telemedicine costs coincided with improved survival rates. Telemedicine intervention decreased overall mortality and length of stay within progressive care units without substantial cost incurrences. 

The full article can be viewed below.

Precision Medicine for Alzheimer’s Disease Prevention
 

Precision medicine is an approach to medical treatment and prevention that takes into account individual variability in genes, environment, and lifestyle and allows for personalization that is based on factors that may affect the response to treatment. Several genetic and epigenetic risk factors have been shown to increase susceptibility to late-onset Alzheimer’s disease (AD). As such, it may be beneficial to integrate genetic risk factors into the AD prevention approach, which in the past has primarily been focused on universal risk-reduction strategies for the general population rather than individualized interventions in a targeted fashion. This review discusses examples of a “one-size-fits-all” versus clinical precision medicine AD prevention strategy, in which the precision medicine approach considers two genes that can be commercially sequenced for polymorphisms associated with AD, apolipoprotein E (APOE), and methylenetetrahydrofolate reductase (MTHFR). Comparing these two distinct approaches provides support for a clinical precision medicine prevention strategy, which may ultimately lead to more favorable patient outcomes as the interventions are targeted to address individualized risks.

The full review can be downloaded below.

Blockchain Technology for Healthcare: Facilitating the Transition to Patient-Driven Interoperability

Authors William J. Gorgon and Christian Catalini review blockchain technology as a way to improve patient centered interoperability.  Interoperability in healthcare has traditionally been focused around data exchange between business entities, for example, different hospital systems. However, there has been a recent push towards patient-driven interoperability, in which health data exchange is patient-mediated and patient-driven. Patient-centered interoperability, however, brings with it new challenges and requirements around security and privacy, technology, incentives, and governance that must be addressed for this type of data sharing to succeed at scale. This paper looks at how blockchain technology might facilitate this transition through five mechanisms: (1) digital access rules,(2) data aggregation, (3) data liquidity, (4) patient identity, and (5) data immutability. This review then look at barriers to blockchain-enabled patient-driven interoperability, specifically clinical data transaction volume, privacy and security, patient engagement, and incentives. It concludes by noting that while patient-driving interoperability is an exciting trend in healthcare, given these challenges, it remains to be seen whether blockchain can facilitate the transition from institution-centric to patient-centric data sharing.

The full review can be accessed below.  
 

Mixing Electronic and Non-Electronic Health Records Limits Physician Productivity - The Arizona Experience

This study aimed to estimate the effects of electronic health records (EHRs) on physician productivity in day-to-day practice by including the combinations of EHRs with nonelectronic records that typify current practice. The potential productivity of EHRs is severly limited by the typical practice of combining EHRs withnon-electronic records. Reducing the number of different types of records used in a practice will increase the positive effects of EHRs on productivity. One requirement for such reductions is an increased availability of health information exchanges.

The full study can be viewed below.  

Pharmacy Customers’ Experiences With Electronic Prescriptions: Cross-Sectional Survey on Nationwide Implementation in Finland

One of the forerunners in electronic health, Finland has introduced electronic prescriptions (ePrescriptions) nationwide by law. This has led to significant changes for pharmacy customers. Despite the worldwide ambition to develop ePrescription services, there are few reports of nationally adopted systems and particularly on the experiences of pharmacy customers.  This study therefore looks at patient perspectives in Finland on ePrescriptions.  Overall, Finnish pharmacy customers are satisfied with the recently implemented nationwide ePrescription system. They seldom have any difficulties purchasing medicines, renewing their ePrescriptions, or acting on behalf of someone else at the pharmacy. Customers usually keep up to date with their ePrescriptions by asking at the pharmacy. However, some customers are unaware of the practices or have difficulty keeping up to date with the status of their ePrescriptions. The provision of relevant information and assistance by health care professionals is therefore required to promote customers’ adoption of the ePrescription system.

The article can be viewed here 

Physicians’ Estimates of Electronic Prescribing’s Impact on Patient Safety and Quality of Care

Electronic prescribing (e-prescribing) is a potentially important intervention that can be used to reduce errors. It provides many potential benefits over handwritten medication prescriptions, including standardization, legibility, audit trails, and decision support. Electronic health record (EHR) and e-prescribing systems may greatly enhance communication and improve the quality and safety of care.  This particular study aimed to better understand physicians' perspectives on e-prescribing in Finland.  Physicians’ perceived usefulness of e-prescribing was significantly associated with patient safety and quality of care. The interoperability of an EHR had a significant effect on both the perceived ease of use and perceived usefulness of e-prescribing. The findings show that experience with an e-prescribing system has a positive effect on participants’ perceived ease of use and perceived usefulness of e-prescribing. This study highlights potential safety and efficiency benefits associated with integrated health information technology in health care. 

The full study can be viewed below.