Archive for 2015

CardioBrief: Indiana Cardiologist Accused of Unnecessary Procedures

Med Page Today – Coverage of a study conducted by researchers at the Dartmouth Institute for Health Policy and Clinical Practice, related to a lawsuit that 293 patients are filing against three doctors at a cardiology practice in Munster, Ind., claiming that the doctors performed needless procedures. The study showed that Munster had some of Indiana’s highest rates per capita for cardiac catheterizations and coronary angioplasties, procedures that, in many cases, can be elective. When investigators studied rates per capita for procedures that must be treated—a hip fracture, for instance—Munster was below average in the state.

Debate Over Early-Stage Cancer: To Treat or Not to Treat?

The Wall Street Journal – Quotes H. Gilbert Welch, professor of medicine, community and family medicine, and of the Dartmouth Institute for Health Policy and Clinical Practice, in an article about how more researchers are suggesting “active surveillance” for certain patients instead of surgery, and whether Americans are being over-treated for early-stage malignancies or precancerous lesions that could possibly have been left alone with little risk of negative effects. “We go too far and end up creating more problems than we solve,” when medicine treats small harmless lesions, says Welch

Silver Lining of Old Age: Ditching the Screenings

Naples Daily News – Quotes Steven Woloshin and Lisa Schwartz, both professors of medicine, community and family medicine, and of the Dartmouth Institute for Health Policy and Clinical Practice, on a recent announcement from the U.S. Preventive Services Task Force that average-risk people can stop getting mammograms for breast cancer and colonoscopies for colon cancer around 75. And, after 65, most women can forget about Pap tests for cervical cancer. “So you don’t have to worry so much about (cancer) screening because you’re more likely to die of something else,” says Woloshin. “That’s a hard conversation for doctors and patients to have.”

Dartmouth Researchers Say Hospital Care for Children Varies

New Hampshire Union Leader – A new study by researchers at Geisel and the Dartmouth Institute for Health Policy and Clinical Practice finds that hospital care for children with complex medical issues varies throughout New England. Co-authors Shawn Ralston, associate professor of pediatrics, David Goodman, professor of pediatrics, and Wade Harrison, manager of special projects at TDI, hope that the study will shed light on how medical decisions are made to improve medical outcomes.

Study: Pediatric Patient Care Varies Greatly Depending on Hospital

VPR – Quotes Shawn Ralston, associate professor of pediatrics, who is the co-author of a recent study which found that children with complex medical needs get different treatment depending on where in Northern New England they receive care. “This is a different patient population and there should be some variation in there. But there shouldn’t be variation at the level we are seeing,” says Ralston.

Addiction, Poor Care Drove N.H. Medicaid Patients to Shop Around for Opioids

NHPR – Quotes Gilbert Fanciullo, professor of anesthesiology and and director of pain management at Dartmouth-Hitchcock Medical Center, about how providers are increasingly aware of the risks of opioids, but that many patients demand them. “Patients are coming into our offices and saying, ‘I’ve tried everything, I still have this pain and I want it treated,'” Fanciullo says. “And it’s very hard for some doctors to tell the patient, ‘No.'” Fanciullo also comments on data from the state of New Hampshire, which found that the strength and number of opioids prescribed to some Medicaid patients who use multiple providers varied greatly from one pharmacy visit to the next. “There is no question that it is poor care, and there is no question that it is dangerous,” says Fanciullo.

ASCO, AAHPM Issue Guidance Statement on Hospice, Palliative Care in Oncology Practice

Healio – Cites comments by Kathleen Bickel, assistant professor of medicine, on a recent study she conducted with fellow researchers to define what constitutes as high-quality primary palliative care delivered by medical oncology practices. “The small workforce of palliative care specialists are insufficient to meet the needs of all patients with cancer in the U.S. who might benefit from these services,” says Bickel.