21 01, 2020

The Top Ten from the NEJM in 2019

2020-01-21T11:11:44+00:00

Paper of the Week: 21st January 2020 This week’s blog is brought to you by: Dr Muir Gray This is a free pdf with the full articles and accompanying editorials https://cdn.nejm.org/pdf/Notable-Articles-of-2019.pdf Authors conclusion We know that physicians need the best information in order to advise patients and to identify these vaping-related illnesses. In early September, we published a report on pulmonary illness related to e-cigarette use in Illinois and Wisconsin. The 53 cases described in this report had patterns of pneu­monitis that included acute eosinophilic pneumonia, organizing pneumonia and lipoid pneumonia, among others. Products that contained THC were the most commonly reported e-cigarette product exposure. 2019 will be remembered for emergence of vaping-related disease and this article was [...]

The Top Ten from the NEJM in 20192020-01-21T11:11:44+00:00
10 09, 2019

Paper of the Week: 10th September 2019 – At last, value measured by the opportunity cost of an intervention

2019-09-10T09:43:21+00:00

This week’s blog is brought to you by: Professor Sir Muir Gray Full reference and title from the journal: Uterus at a price: Disability insurance and hysterectomy Fan E. (et al) Journal of Health Economics 66 (2019) 1-17 Link to Paper: https://www.sciencedirect.com/science/article/abs/pii/S0167629618308142?dgcid=rss_sd_all Authors conclusion: Taiwanese Labor, Government Employee, and Farmer Insurance programs provide 5 to 6 months of salary to enrollees who undergo hysterectomies or oophorectomies before their 45th birthday. These programs create incentives for more and earlier treatments, …..Induced hysterectomies increase benefit payments and surgical costs, at about the cost of a mammogram and 5 pap smears per enrollee. 3V bottom line: Expressing value in terms of other things that could be one with the same amount [...]

Paper of the Week: 10th September 2019 – At last, value measured by the opportunity cost of an intervention2019-09-10T09:43:21+00:00
2 08, 2019

Paper of the Week 2nd August: Lessons on paying for value from the US health policy laboratory

2019-08-02T06:20:37+00:00

This week's blog is brought to you by Dr Tim Wilson, 3V Managing Director. Full reference: Health Care Spending, Utilization, and Quality 8 Years into Global Payment Song, Z., Ji, Y., Safran, D. G., & Chernew, M. E. (2019). Health Care Spending, Utilization, and Quality 8 Years into Global Payment. New England Journal of Medicine, 381(3), 252–263. Web Link to Paper Authors conclusion: During the first 8 years after its introduction the Alternative Quality Contract of Blue Cross Blue Shield (BCBS) of Massachusetts, a population-based payment model, was associated with slower growth in medical spending on claims, resulting in savings that over time began to exceed incentive payments. Unadjusted measures of quality under this model were higher than [...]

Paper of the Week 2nd August: Lessons on paying for value from the US health policy laboratory2019-08-02T06:20:37+00:00
22 07, 2019

Paper of the Week – 22nd July 2019: The 7 Habits of Highly Effective Cost-of-Care Conversations

2019-07-22T06:46:10+00:00

  This weeks blog is brought to you by: Professor Sir Muir Gray, Founding Director. Authors conclusion Cost-conversation practice certainly will not make us perfect, given the logistical and informational barriers that exist. However, it will move us closer to the kind of patient-centered care that characterizes the ideals of our profession.   Text from the paper chosen by 3VH (this may, or may not be the ‘conclusion’) Out-of-pocket expenditures have increased rapidly in the United States over the past decade. In 2018, 29% of people with private insurance were enrolled in high-deductible health plans, compared with just 4% in 2006. Out-of-pocket costs are high for many publicly insured people, too. Medicare beneficiaries with cancer who do not [...]

Paper of the Week – 22nd July 2019: The 7 Habits of Highly Effective Cost-of-Care Conversations2019-07-22T06:46:10+00:00
12 07, 2019

Paper of the Week 12th July 2019: Why are we wasting precious resources to deliver low value at the end of life?

2019-07-12T10:02:02+00:00

Warraich, H. J., & Meier, D. E. (2019). Serious-Illness Care 2.0 — Meeting the Needs of Patients with Heart Failure. New England Journal of Medicine, 380(26), 2492–2494. https://doi.org/10.1056/NEJMp1900584 WEB LINK TO PAPER   This week's paper of the week is brought to you by Dr Tim Wilson, Managing Director   Authors conclusion Heart failure is the most common cause of hospitalizations among elderly Americans, and despite much medical and scientific progress, it remains a source of substantial suffering, expense, and caregiver burden. Palliative care can improve quality of life, symptoms, and functioning for people with serious illnesses, and a recent observational study in patients with heart failure showed that enrollment in home hospice was associated with fewer emergency [...]

Paper of the Week 12th July 2019: Why are we wasting precious resources to deliver low value at the end of life?2019-07-12T10:02:02+00:00
5 07, 2019

Paper of the Week 5th July 2019: The inverse care law continues to thrive in the NHS for vascular surgery (and probably more)

2019-07-05T17:19:32+00:00

Giuseppe Moscelli, Luigi Siciliani, Nils Gutacker, Richard Cookson (2018) Socioeconomic inequality of access to healthcare: Does choice explain the gradient? Journal of Health Economics, 57, 290–314.   This week's blog is brought to you by: Dr Tim Wilson   Bottom Line For planned vascular surgery, there is inequity in NHS provision for people living in the poorest and wealthiest neighbourhoods, representing an addressable cause of lower value.   Authors conclusion Equity of access is a key policy objective in publicly-funded healthcare systems. However, observed inequalities of access by socioeconomic status may result from differences in patients’ choices. Using data on non-emergency coronary revascularisation procedures in the English National Health Service, we found substantive differences in waiting times within [...]

Paper of the Week 5th July 2019: The inverse care law continues to thrive in the NHS for vascular surgery (and probably more)2019-07-05T17:19:32+00:00
21 06, 2019

Paper of the Week 21st June 2019: What Are Polygenic Scores and Why Are They Important?

2019-06-21T09:24:07+00:00

Full reference: Sugrue L.P. and Rahul S. Desikan, R.S JAMA May 14, 2019 Volume 321, Number 18 1820 -1821 This weeks blog is brought to you by: Professor Sir Muir Gray WEB LINK TO PAPER Authors conclusion - Text from the paper chosen by 3VH Value “The value of polygenic risk scores cannot be assessed until the clinical utility has been established through research studies that evaluate their use in clinical practice and therapeutic trials. Companies are already offering these tests directly to consumers at costs ranging from one to a few hundred dollars. As whole-exomesequencing and whole genomesequencing become less expensive and more widely available, it should be possible to compute any polygenic score from an individual’s [...]

Paper of the Week 21st June 2019: What Are Polygenic Scores and Why Are They Important?2019-06-21T09:24:07+00:00
14 06, 2019

Paper of the Week: The health equity measurement framework: a comprehensive model to measure social inequities in health

2019-06-14T11:26:50+00:00

Full reference: Dover D.C. and Belon A.P.(2019) International Journal for Equity in Health 18;36 WEB LINK TO PAPER   This weeks blog is brought to you by: Professor Sir Muir Gray, Founding Director   Authors conclusion; Text from the paper chosen by 3VH. This paper presented a complex, overarching measurement framework for health equity.  The HEMF is a synthesis of existing SDOH (Social Determinants of Health) and health system utilisation frameworks and current literature.  Yet, its purpose extends to focus on measurement. It is specifically designed to help identify and measure the interrelationships between political and socio-cultural context, health system-related policies and programs, material and social circumstances, environment, biological and psychosocial factors, perceived and evaluated needs, social location, [...]

Paper of the Week: The health equity measurement framework: a comprehensive model to measure social inequities in health2019-06-14T11:26:50+00:00
7 06, 2019

Paper of the Week: Optimality in cancer redefined for the 21st century

2019-06-07T08:00:07+00:00

This weeks blog is brought to you by: Sir Muir Gray, Founding Director   Authors conclusion “I’ve always had a peculiar fascination for the receiver-operating characteristic (ROC) curve. As a researcher, I appreciate that the area under the curve can be precisely mapped, so that different screening or diagnostic tests can be meaningfully compared. This lovely interweaving of my clinical and academic perspectives took an unexpected turn just over a year ago, when I was diagnosed with breast cancer. I hadn’t reckoned on the price of treatment. The complications. The treatment of complications. The side effects of the treatment of complications. The sepsis. The relapsing, migratory pneumonia from radiation-induced lung injury. The sleep deprivation, agitation, and bone loss [...]

Paper of the Week: Optimality in cancer redefined for the 21st century2019-06-07T08:00:07+00:00
29 05, 2019

Paper of the Week: Knights and Knaves; even with the “wrong” incentives, most clinicians exhibit a culture of stewardship

2019-05-29T12:35:12+00:00

Full reference: Guida, S. et al Testing the myth of fee‐for‐service and overprovision in health care. Health Economics. 2019;28:717–722. This week's paper of the week is brought to you by Dr Tim Wilson, Managing Director   Bottom line When it comes to improving value-based population health, nurturing a culture of stewardship reminds more important than clever design of payment systems. This study shows that the wrong payment system might increase over-provision of care. But importantly, because of an inherent culture of stewardship, patient value and system sustainability trump personal financial gain. Summary from authors We observe that decreasing the fee size has an effect on over-provision under both market conditions. We also observe that patients who are harmed [...]

Paper of the Week: Knights and Knaves; even with the “wrong” incentives, most clinicians exhibit a culture of stewardship2019-05-29T12:35:12+00:00