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Groups focus on reducing five overused medical treatments

Thursday August 15, 2013
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The Joint Commission and a committee of the American Medical Association have issued a series of specific strategies to reduce five medical interventions or treatments that are commonly used but not always necessary.

In a paper, The Joint Commission and AMA-Convened Physician Consortium for Performance Improvement offer approaches to address the overuse of antibiotics for viral upper respiratory infections, over-transfusion of red blood cells, tympanostomy tubes for middle ear effusion of brief duration, early-term non-medically indicated elective delivery and elective percutaneous coronary intervention.

Overuse has been described as the provision of medical interventions or treatments that provide zero or negligible benefit to patients, potentially exposing them to the risk of harm. Sometimes overlooked or neglected as a leading contributor to problems with quality and patient safety, overuse of these medical treatments and interventions affects millions of patients, according to a news release. Overuse also drives up healthcare costs, with an estimated $1 billion spent annually on unnecessary antibiotics for adults with viral upper respiratory infections alone.

In the paper, the five advisory panel work groups that tackled the areas of overuse suggest common strategies to support a culture of safety and mindfulness, promote further patient education, remove incentives that encourage overuse, encourage further study and spur other professional organizations to collaboratively address overuse.

The advisory panel work groups also recommend steps specific to each of the five areas targeted for reduction. Among the recommendations are:

• Antibiotic use for viral upper respiratory infections — develop clinical definitions for viral and bacterial upper respiratory infections, align current national guidelines that are contradictory, partner with the CDC, and initiate a national education campaign on overuse of antibiotics for viral upper respiratory infections.

• Appropriate blood management — develop a toolkit of clinical education materials, expand education on transfusion avoidance and appropriate alternatives to transfusion, and develop a separate informed consent process for transfusion that communicates the risks and benefits.

• Tympanostomy tubes for middle ear effusion of brief duration — develop performance measures for appropriate use of tympanostomy tubes, determine the frequency with which tympanostomy tubes are performed for inappropriate indications in otherwise healthy children, and focus national research on issues related to tympanostomy tubes, including the role of shared decision-making with parents and other caregivers.

• Early-term non-medically indicated elective delivery — standardize how gestational age is calculated, make the early elective deliveries indications and exclusion list as comprehensive as possible to improve clinical practice, and educate patients and clinicians about the risk of non-medically indicated early elective deliveries.

• Elective percutaneous coronary intervention — encourage standardized reporting in the catheterization and interventional procedures report, encourage standardized analysis/interpretation of non-invasive testing for ischemia, focus on informed consent and promote patient knowledge and understanding about the benefits and risks of PCI, and provide public and professional education.

Download the report: http://www.jointcommission.org/overuse_summit/.


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