NEJM Catalyst

The June issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on inequities and disparities in care delivery, remote patient monitoring, virtual care clinics, value-based procurement, and a health system research and education division: https://nej.md/4dEmMYa Read or listen to our letter from the editors: Assessments and Action on Disparities in Care Delivery: https://nej.md/3wokkoc Insights Report: Unequal Treatment: Disparities in Care Continue: https://nej.md/4bFskjB with Consuelo H. Wilkins, M.D., Vanderbilt University Medical Center Insights Interview: How Health Care Leaders View Disparities in Care: https://nej.md/44L91TM with Leonor Fernández, Beth Israel Lahey Health, Beth Israel Deaconess Medical Center; Deneen Richmond, Luminis Health, Luminis Health Doctors Community Medical Center; Alexander Garza, SSM Health Case Study: A Novel Value-Based Procurement Agreement to Improve Outcomes for Patients Undergoing Knee Replacement: https://nej.md/3WFP9iz with Rodolfo Catena, Karsten Kirkegaard, Dr Deepti Nayak, Sonila M. Tomini, University College London, The Region of Southern Denmark (Region Syddanmark) Case Study: Enhancing Community-Based Specialty Access Through Virtual Care: https://nej.md/4bE5qc6 with Nirmal Kaur, M.D., Krupali Patel, MS, MHA, Mei Lu, Yara Dababneh,MD, Diana Jomaa, Ankita Nagirimadugu, Poornima Oruganti, Kevin Yee, Henry Ford Health Case Study: Targeting Racial Inequities in Inpatient Pulmonary Specialty Care Access: https://nej.md/4bDU480 with Caitlin Clancy, Janae Heath, Anna Winston, Jessica Lee, Rachel Kohn, Penn Medicine, University of Pennsylvania Health System Case Study: Developing and Scaling Remote Patient Monitoring Capacity in Ambulatory Practice: https://nej.md/4anh4av with Nina Singh, Katharine Lawrence, Katerina Andreadis, Chelsea Twan, Devin Mann, NYU Langone Health, NYU Grossman School of Medicine In Depth: A Learning Health System to Generate and Accelerate Innovation: The HealthPartners Institute: https://nej.md/3WujBw0 with Nicolaas Pronk, Jeanette Augustson, Thomas Kottke, Steven Dehmer, PhD, Karen Margolis, Kelly Frisch, MD, HealthPartners

On June 27, 12-2pm ET, join us for a free virtual event, "Patient-Centered Innovation: Key Steps for Clinicians, Purchasers & Payers": https://nej.md/4bokgUI #NEJMCatLive

Efforts by health care organizations to address racial inequities have yielded some promising results. However, iterative and ongoing evaluation and quality improvement measures for both inpatient and outpatient pulmonary care are critical: https://nej.md/4bDU480

The development of four virtual care sites, each between 75 and 200 miles from the urban tertiary care center, has contributed to improved access to specialized care and better clinical outcomes: https://nej.md/4bE5qc6

Early results of a value-based procurement agreement for knee replacement at Vejle Hospital show promise. Clinically reported data indicate reductions in readmissions 30 days after discharge and improved patient-reported outcomes 1 year after surgery: https://nej.md/3WFP9iz

NEJM Catalyst Insights Council members discuss equity in care delivery: https://nej.md/44L91TM

NEJM Catalyst Insights Council members say improving equity in health care is personally important to them, but real progress is lacking: https://nej.md/4bFskjB

The June 2024 issue of NEJM Catalyst Innovations in Care Delivery underscores the need for progress in addressing unequal health care, and offers hope: https://nej.md/3wokkoc

Patients with advanced cancer often receive treatment and acute care that is discordant with their preferences at the end of life. Serious illness conversations (SICs) with patients with cancer about their goals and treatment preferences may improve their mood and quality of life and decrease health care use. However, most patients with cancer die without a documented SIC. The dearth of SICs with such patients can be attributed to numerous factors, including inaccurate prognostication and lack of clinicians’ willingness to engage in the conversations, which may result in an excess of low-value care.    Initiating SICs after diagnosis to facilitate care that is concordant with patients’ goals may decrease unwanted care and associated health care expenditures near the end of life. Indeed, several retrospective studies have confirmed an association between earlier SICs and reduced net costs of care, including decreased hospital out-of-pocket expenses. However, prospective trials of SIC interventions have largely not demonstrated cost savings, perhaps because the interventions used were insufficient to target clinicians’ interactions with high-risk patients. To address this shortcoming, Tej A. Patel and colleagues conducted a stepped-wedge cluster randomized, controlled trial that evaluated the effect of nudges to clinicians to prompt SICs with high-risk patients. Such patients were previously identified by a validated machine-learning (ML) algorithm to be at high risk for death within 6 months. A preliminary analysis at 16 weeks showed that the intervention was associated with significant increases in SIC rates among all patients and high-risk patients, and a long-term analysis at 40 weeks demonstrated that the intervention decreased end-of-life systemic therapy use.    In this current secondary analysis of the trial, the authors evaluated the impact of SIC nudges to clinicians on end-of-life spending in a cohort of decedents who died during the trial’s observation period. They hypothesized that patients who received the intervention would have lower daily spending in the last 6 months of life than those who did not receive the intervention.    Read the full results in the Original Article “Spending Analysis of Machine Learning–Based Communication Nudges in Oncology” by Tej A. Patel et al.: https://nejm.ai/4aq6oIb    #ArtificialIntelligence #AIinMedicine 

Clinician shortages are a global emergency. Many clinicians have left their jobs, and even their profession, resulting in unsustainable workloads, burnout, and exhaustion for their former colleagues. Addressing the problem has required multi-layered approaches, innovative solutions, and new care models to fix the shortage in the short-term while planning for longer-term sustainable solutions. Our new free PDF collection features insights, analysis and firsthand views from clinical leaders around the globe, chronicling the magnitude of the staffing crisis across the profession, including primary care and post-acute care, while highlighting creative solutions for a sustainable path forward. Download "Navigating the Clinician Shortage Crisis" from https://nej.md/4dR8Yda