shared decision making

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
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
2 01, 2019

Paper of the week 02.01.19: Evidence and values in the NHS

2019-01-02T14:14:45+00:00

Reference: Evidence and values in the NHS: choosing treatments and interventions well. Margaret McCartney and Sam Finnikin. Br J Gen Pract 2019;  69 (678): 4-5 This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V Executive Director. Bottom line (chosen from the paper) But there is a concern that ‘value’ as currently practised may mean monetary cost coming first, and may be used to describe the values of a balanced accounting sheet rather than the personal values of an individual patient. Higher-quality care may happen to be less expensive, but cost should not be the sole arbiter. Yet the opportunity cost of doctors having to explain why CCGs are no longer funding prescriptions for ‘self-limiting’ conditions, rather than doing [...]

Paper of the week 02.01.19: Evidence and values in the NHS2019-01-02T14:14:45+00:00
17 10, 2018

Paper of the week 17.10.18: Trying to convince people to poo in toilets – what the NHS needs to learn

2018-10-17T11:45:26+00:00

Reference: Rural Sanitation in India: The Poo Party This weeks paper of the week is brought to you by Dr Anant Jani, 3V Executive Director. Bottom line “Transforming the behavioral norms of rural populations is a particularly challenging task, and it will only work if rural communities change from within…much depends on the extent to which civil society takes up the call, and whether and how the government pitches in to sensitize and support the fight….The other half of the challenge is uprooting deep-seated beliefs and taboos…Success will require long-term campaigns to spread awareness, the development of regionally contextualized innovations, focus-group discussions, and women’s empowerment.” Implications for value improvement  Getting people to change is not easy.  Habits, beliefs and [...]

Paper of the week 17.10.18: Trying to convince people to poo in toilets – what the NHS needs to learn2018-10-17T11:45:26+00:00
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