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Doctors receive a lot of advice on starting treatment. This can help stop them



New framework to build

Kerr, a colleague of Michigan Medicine, UM’s Academic Medical Center, and the VA Ann Arbor Healthcare System have announced that their new paper will provide specific guidance on proper size care by guideline developers. It emphasizes that it shows the framework of the effort.

The first set of recommendations is tailored for adult primary care. However, the authors note that the association of experts developing treatment guidelines can take an approach to more accurately formulate future recommendations, including when to stop or reduce, as well as when to start treatment or screening. I’m looking forward to it.

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For example, people with diabetes get older, so they don’t have to take multiple medications to lower their blood sugar and blood pressure to their goals when they were young. That’s because the evidence supporting these low goals came from studies focused on the prevention of diabetes-related problems decades into the future. In addition, older patients are at increased risk of hypoglycemia that these medications can cause.

Or, in another example, a man who is accustomed to regular blood tests for prostate-specific antigens that may be a sign of prostate cancer is African-American or has prostate cancer and is therefore at increased risk.

Non-enhancements based on these types of guidelines have undergone a thorough review to identify those that clearly state when and for whom treatment or testing should be reduced, and a confirmatory assessment by field experts. After doing, it was only included in the appendix of the new paper.

“We hope this will be a reproducible process for identifying and identifying opportunities to mitigate care, with sufficient information to guide the measurements,” Kerr said.

However, she and her colleagues firmly state that individual physicians should not be punished for neglecting decentralization of care because of the important role of patient preference and clinical nuances. .. Instead, healthcare systems can use highly specified recommendations from this study to track and improve non-strengthening of the patient population.


Over time, if your health system incorporates weight loss recommendations into your electronic medical record system, you can encourage your doctor to discuss weight loss with the right patient. You can also track aggregated data about overall system performance.

“We need to move towards a balanced location in the provision of clinical care,” said the senior author. Timothy Hofer, MD, Master, UM professor of internal medicine and VA CC MR researcher. “If we recommend starting a form of care, we need to state when to stop and include details about population and time, and actions to do so.”

The author points to data from a national poll on healthy aging, based on UM’s Healthcare Policy and Innovation Institute. Only 14% of older people think that “usually more is better” When it comes to healthcare, 25% agree with the statement that healthcare providers often require tests and treatments that patients don’t think they need.

In an accompanying editorial, also published today, evidence-based medical researchers, Radimeta, MD, and Richard Lehman, BM, B.Clinical practice always involved the decision to do less — It just lacks the momentum and formalization needed for widespread support. Guidelines focused on decentralization may signal changes needed to help healthcare professionals reverse unnecessary care trends and do more against existing prejudices. not. “

The team that wrote the new paper is now working to investigate how often patients are receiving too much treatment, which may have been appropriate for them in the past. Car Michigan Program on Value Enhancement At IHPI, IHPI researchers and Michigan medicine clinicians come together to develop and test new ways to provide the right size of care in the real world.

In addition to Kerr and Hofer, the authors of the new study are Mandi L. Klamerus, MPH. Adam A. Markovitz, BS; Jeremy B. Sasman, Maryland, Master’s Degree; Stephen J. Bernstein, MD, MPH; Tanner J. Caverly, MD, MPH; Roger Chow, MD; Lilian Min, MD, MSHS Sameer D. Saini, MD, MS; Shannon E. Roman, BS; Sara E. Scarla, MPH; David E. Goodrich, Ed.D.; This study was funded by the Department of Veterans Affairs (HSR & D). Grant IIR 15-131).

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