How do we improve the value of care delivered in primary care? with John Mafi

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All of us like to think that we provide high-value care for our patients; but the truth is, just like the rest of the health care system, primary care provides a lot of low value care too – and we drive a lot of overuse. John Mafi joins us this week to talk about his leading research into these thorny, complex issues.

We talk about the definitions of high-value and low value care, his 2016 study in Annals of Internal Medicine examining rates of high and low value care among physicians, NPs, and PAs in the primary care setting, how practice setting may affect the delivery of high and low value care, and the essential truth that there is no free lunch in trying to solve some of the challenges in fixing primary care in the US. You can find Shah et al, which John referenced here; a recent study relevant to our conversation by Hong et al looking at clinician characteristics and frequent ordering of low-value imaging studies; and an extremely important new paper that John published recently in Health Affairs looking at the the impact of low-cost, high-volume studies on unnecessary health spending.

A little bit more about our guest:  John N. Mafi, MD, MPH is an assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA where he also practices and teaches. He also serves as an Affiliated Natural Scientist in Health Policy at RAND Corporation. Dr. Mafi trained in internal medicine at Beth Israel Deaconess Medical Center in 2012, where he also served as Chief Medical Resident and completed the Harvard Medical School Fellowship in General Internal Medicine and Primary Care in 2015. Dr. Mafi’s research focuses on quality and value measurement and how electronic health records can improve the value of care.

If you enjoy the show, please give us 5 stars wherever you listen. Tweet us your thoughts @RoSpodcast and leave us a message on our facebook page at www.facebook.com/reviewofsystems. Or, you can email me at audrey@rospod.org. We’d love to hear from you, and thanks for listening.

 This interview has been lightly edited for length and clarity.

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status – Mehta et al

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This week, we are discussing an article from the Journal Women’s Health Issues, entitled: Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status, by Pooja Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, and Sindhu Srinivas. Pooja Mehta, the lead author of the study, joins us for our conversation. 

You can find the interview with Dr. David Buck referenced in our conversation here.

Dr. Mehta is Director of Maternal & Women’s Health Policy for the Consortium for Health Care Transformation, and Assistant Professor of Health Policy and Systems Management and Obstetrics and Gynecology at the Louisiana State University Health Sciences Center, advising the Louisiana Department of Health and Medicaid Program.

Dr. Mehta’s interests are in the use of health care delivery innovation and community-engaged accountable care models to reduce reproductive health disparities, pregnancy-associated mortality, and low-value care, and to support patients with complex health and social needs. Her research has been supported by the Health Resources and Services Administration, the American College of Obstetricians and Gynecologists, and the Leonard Davis Institute of Health Economics.

If you like the show, please rate and review us on itunes, google play, stitcher or your favorite podcasting app, which makes the show easier for others to find; and share us on social media. We tweet at @RoSpodcastand are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at audrey@rospod.org. We’d love to hear from you.

Listen at the end of the episode for a promo code to receive 15% off registration fees for an upcoming conference from the Harvard Center for Primary Care: Primary Care in 2020 – Future Challenges, Tips for Today.

This interview has been lightly edited for length and clarity.

Journal Club – Association Between Process Measures & Mortality in Individuals with Opioid Use Disorders

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This week, we are discussing a recent article from the journal Drug and Alcohol Dependence, entitled: Association between process measures and mortality in individuals with opioid use disorders, by Katherine Watkins and colleagues: Susan Paddock, Teresa Hudson, Songthip Ounpraseuth, Amy Schrader, Kimberly Hepner, and Bradley Stein. We are also joined by a guest discussant, Gabriel Wishik. Gabriel Wishik is a clinician educator in general and addiction medicine, and is an instructor at Boston University and Boston Medical Center. He is the clinic medical director at Boston’s Healthcare for the Homeless Program’s largest clinical site and practices harm reduction in primary care with a population at the front lines of the current opioid epidemic. You can find the obituary we shared on the show here.

If you like the show, please rate and review us on itunes, google play, stitcher or your favorite podcasting app, which makes the show easier for others to find; and share us on social media. We tweet at @RoSpodcastand are on facebook at www.facebook.com/reviewofsystems.  Please drop us a line at contact@rospod.org. We’d love to hear from you.

Listen at the end of the episode for a promo code to receive 15% off registration fees for an upcoming conference from the Harvard Center for Primary Care: Primary Care in 2020 – Future Challenges, Tips for Today.

This interview has been lightly edited for length and clarity.

David Levine: Home Hospital Research

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On our premier show, Dr. David Levine, a general internist and research fellow in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital and Harvard Medical School talks about his research looking at home hospitalization. Instead of admitting patients to the floors from the ED, he admits them back home. He also reflects on some of his other research and interests in the quality of outpatient care, digital health technology, and novel methods of care delivery.

Check out an article about David’s research in the Boston Globe, a video about his home hospital work, and one of his other publications that we talk about in the show, comparing doctors to symptom checking software.

We also reference Bruce Leff, a leader of the home hospital movement in the US; Community Servings, an organization in the Boston area dedicated to bringing wholesome food to the chronically ill; and Iora Health, an innovative healthcare delivery organization.