personal value

17 05, 2019

Paper of the Week 17th May 2019:Measuring What Matters in Diabetes

2019-05-17T11:48:31+00:00

Full reference: MA. Published online April 15, 2019. doi:10.1001/jama.2019.4310 This weeks blog is brought to you by: Professor Sir Muir Gray, Founding Director Authors conclusion “The rationale for using HbA1c level as a surrogate for diabetes outcomes is predicated on the assumption of its direct correlation with outcomes that patients ultimately value, including clinical microvascular disease (eg, ESKD and need for dialysis, blindness, neuropathic pain, amputation), macrovascular disease (eg, myocardial infarction, stroke, painful neuropathy), quality of life, and death. Yet, the strength of this relationship has been called into question. Meta-analyses revealed a null association between intensive glycemic control and these patient-important outcomes, with the sole exception of a 10% to 15% relative risk reduction of nonfatal myocardial [...]

Paper of the Week 17th May 2019:Measuring What Matters in Diabetes2019-05-17T11:48:31+00:00
10 05, 2019

Paper of the Week: 10th May 2019: Better payment systems can support, but not replace, culture change

2019-05-10T08:24:07+00:00

  Full reference: Maryland’s Experiment With Capitated Payments For Rural Hospitals: Large Reductions In Hospital-Based Care. Jesse M. Pines, Sonal Vats, Mark S. Zocchi, Bernard Black. (2019) HEALTH AFFAIRS . Vol. 38, NO. 4 Link to Paper This week’s blog is brought to you by: Dr Tim Wilson, Managing Director Authors conclusion Inpatient admissions and outpatient services fell sharply at [study] hospitals, increasingly so over the period that [capitated payment] was in effect. Emergency department (ED) admission rates declined 12 percent, direct (non-ED) admissions fell 23 percent, ambulatory surgery center visits fell 45 percent, and outpatient clinic visits and services fell 40 percent. However, for residents of [capitated payment] counties, visits to all Maryland hospitals fell by lesser amounts and Medicare spending increased, [...]

Paper of the Week: 10th May 2019: Better payment systems can support, but not replace, culture change2019-05-10T08:24:07+00:00
26 04, 2019

Paper of the Week: 26th April 2019: Shared Decision Making and the Importance of Time

2019-04-26T12:46:40+00:00

  For many professionals, and almost all patients , the value of time is more precious than money Full reference: Pieterse A.M., Stiggelbout A.M.,  Montori V.M. JAMA. Published online April 19, 2019. doi:10.1001/jama.2019.3785 This weeks Paper of the Week is brought to you by Sir Muir Gray, Founding Director. WEB LINK TO PAPER Authors conclusion “health care professionals, patient advocates, health care systems, and policy makers need to recognise that time is not simply a resource, its minutes indifferent and interchangeable like dollars or euros. A minute spent in providing information may turn out to be less important than a minute spent waiting silently for patient questions, or a minute responding emphatically to angst and loss, or a [...]

Paper of the Week: 26th April 2019: Shared Decision Making and the Importance of Time2019-04-26T12:46:40+00:00
11 04, 2019

Paper of the Week: 11.04.2019: Breast Cancer Treatment, what to start, what to stop?

2019-04-11T17:36:53+00:00

Full Reference: Overall Survival with Fulvestrant plus Anastrozole in Metastatic Breast Cancer, Rita S. Mehta, Et al, N Engl J Med 2019; 380:1226-1234, DOI: 10.1056/NEJMoa1811714 Web link to Paper  This week’s blog is brought to you by: Dr Tim Wilson Authors conclusion In this trial, we found that combination therapy with anastrozole plus fulvestrant significantly prolonged, as compared with treatment with anastrozole alone, the primary and secondary end points of progression-free survival (P=0.007) and long-term overall survival (P=0.03) when used as first-line therapy for hormone-receptor–positive metastatic breast cancer in postmenopausal women. 3VH - Implications for value Another promising treatment emerges for breast cancer. Not a cure, but one that prolongs survival from 42 to 49.8 months in women [...]

Paper of the Week: 11.04.2019: Breast Cancer Treatment, what to start, what to stop?2019-04-11T17:36:53+00:00
27 03, 2019

Paper of the Week 27.03.2019: Toward Precision Policy — The Case of Cardiovascular Care

2019-03-27T16:12:11+00:00

This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V’s Founding Director. Author’s conclusion “If we are serious about improving quality of care and patient outcomes — whether mortality, readmissions, or patient centered [clinical] outcomes such as freedom from angina or heart failure symptoms — we have a responsibility to ensure that policies are grounded in evidence. We believe it’s imperative that before policies are implemented widely, rigorous studies be conducted to determine whether they achieve their goals. In addition to taking an evidence- first approach to policy implementation, we can better target policies toward specific diseases… As we move toward precision medicine and the delivery of diagnostic and therapeutic advances individualized [...]

Paper of the Week 27.03.2019: Toward Precision Policy — The Case of Cardiovascular Care2019-03-27T16:12:11+00:00
21 03, 2019

Paper of the Week 21.03.2019: Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years

2019-03-21T16:17:14+00:00

  This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V's Founding Director. Bottom line, chosen by Muir from the paper Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. The conclusion is This study shows that in the case of CABG more in healthcare is often no better. Once again Avedis Donabedian’s illustration about optimality has been demonstrated. Implications for value improvement  This is another example of the principle first described by Avedis Donabedian and expressed through his diagrammatic representation [...]

Paper of the Week 21.03.2019: Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years2019-03-21T16:17:14+00:00
7 03, 2019

Paper of the Week 07.03.2019: Future Directions in Valuing Benefits for Estimating QALYs: Is Time Up for the EQ-5D?

2019-03-07T12:21:36+00:00

Reference: Brazier J. E. et al (2019  This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V’s Founding Director. Bottom line, chosen by Muir from the paper This raises the issue of what is meant by “well-being.” A broad conception of well-being is how well an individual’s life is going on. Subjective well-being (SWB) has been described or categorised into 3 types: hedonism (well-being increases when an individual experiences more pleasure and/or less pain), flourishing theories (well-being increases when an individual fulfils their nature as a human being, or “flourishes”), and life evaluation or life satisfaction (well-being increases when an individual positively assesses his or her life). The notion of SWB is [...]

Paper of the Week 07.03.2019: Future Directions in Valuing Benefits for Estimating QALYs: Is Time Up for the EQ-5D?2019-03-07T12:21:36+00:00
1 03, 2019

Paper of the week 27.02.19: Has the NHS Long Term Plan forgotten we are all going to die?

2019-03-01T11:14:40+00:00

Reference: Has the Long Term Plan forgotten we are all going to die? (Bleakley T., Smith R., Taylor R) This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V’s Founding Director. Bottom line, chosen by Muir from the paper "One certainty is that there will be a lot of dying in the next 10 years as the baby boomers become the dying boomers... Increasingly, people endure slow deaths of frailty, often with dementia in the final years. Increased life expectancy is generally regarded as a cause for celebration, but many people fear dependency and dementia more than they fear death... Between a quarter and a third of health-care expenditure is for care [...]

Paper of the week 27.02.19: Has the NHS Long Term Plan forgotten we are all going to die?2019-03-01T11:14:40+00:00
13 02, 2019

Issue of the month – February 2019: End of Life Care

2019-02-13T08:55:47+00:00

Authors: Dr Karen Chumbley, Medical Director, St Helena Hospice and Dr Tim Wilson, 3V Bottom Line Much progress has been made since the End of Life strategy was published by the NHS in 2008. But more needs to be done; depending on where you live will alter the chance that you will die in the place you wish. For people dying with some conditions, more work is needed. And sadly, inequity appears to persist, even at this most moment in our life. We might hope that when we are dying, the health and care services, and the voluntary sector would work together to achieves the outcomes we wish. Multiple surveys have confirmed, for instance, that most people would [...]

Issue of the month – February 2019: End of Life Care2019-02-13T08:55:47+00:00
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