ATLANTA – Patients with non–small cell lung cancer and fewer than four brain metastases treated with stereotactic radiosurgery had better overall survival than did similar patients treated with whole-brain irradiation in a nonrandomized observational study.

The study of 413 patients who were eligible for either treatment showed that the median overall survival was 9.0 months for those treated with stereotactic radiosurgery (SRS) alone, versus 3.9 months for those treated with whole-brain radiation therapy (WBRT) alone, reported Dr. Lia M. Halasz, assistant professor of radiation oncology at the University of Washington in Seattle.

The findings suggest the need for a randomized clinical trial comparing the two treatment strategies in patients with non–small cell lung cancer and up to three brain metastases, she said at the annual meeting of the American Society for Radiation Oncology.

"This observational data may better reflect real-world practice; however, the caveat is that all of these patients were treated at large NCCN [National Comprehensive Cancer Network] institutions, and may not reflect practices all across the United States," she said.

Dr. James B. Yu, a therapeutic radiologist and cancer outcomes researcher at Yale University, New Haven, Conn., commented that the study shows "at the very least, NCCN sites are doing a very good job at selecting patients for radiosurgery." Dr. Yu, the invited discussant, was not involved in the study.

There have been no randomized clinical trials directly comparing SRS alone vs. WBRT alone in patients with newly diagnosed brain metastases, and the optimal treatment for such patients is unknown, Dr. Halasz said. The investigators therefore undertook an observational study to determine whether one strategy had a therapeutic advantage over the other.

They identified 413 patients diagnosed with brain metastases without leptomeningeal disease from an NCCN longitudinal database from November 2006 through January 2010. The patients had all received radiation therapy with no neurosurgical resection within 60 days of diagnosis.

Of this group, 118 (29%) underwent SRS, 295 (71%) had WBRT; and 13 patients (3%) had both as initial treatment.

Patients with three or fewer metastases were significantly more likely to receive SRS than WBRT, whereas those with four or more metastases were more likely to receive WBRT (P less than .001). Other factors associated with choice of SRS were smaller metastases (P = .036) and one or no sites of extracranial disease, compared with two or more (P = .013).

The authors analyzed a subset of 197 patients with fewer than four brain metastases and all metastatic sites smaller than 4 cm, all of whom were eligible for either treatment, and 48% of whom underwent SRS alone. As noted before, the unadjusted overall survival in this group was 9.0 months for the SRS-treated patients, and 3.9 months for those treated with WBRT.

To compensate for patient-selection biases, the authors then performed a propensity score analysis in which they stratified patients by their propensity to receive radiosurgery. In this analysis, the estimated treatment effect of SRS on overall survival was a hazard ratio (HR) of 0.62 (P = .018). Factors significantly associated with overall survival included SRS vs. WBRT, number of brain metastases, extent of extracranial disease, institution, and year of treatment.

In an analysis using a standardized mortality-ratio weighing method, they found that the estimated treatment effect of SRS on overall survival was an HR of 0.67 (P = .007).

Additionally, the authors performed a sensitivity analysis of potential unmeasured confounders, assuming that patients who underwent WBRT were three times more likely to have a Karnofsky performance score less than 70, and that the HR for that poor performance status was 2.13, based on recursive partitioning analysis (RPA) status. In this analysis, the HR favoring SRS was 0.64 (P = .037).

Finally, they performed a companion analysis with breast cancer data, and found a similar HR in favor of SRS (HR, 0.59; P = .036)

The funding source for the study was not reported. Dr. Halasz and Dr. Yu reported having no conflicts of interest to disclose.

ATLANTA – Patients with non–small cell lung cancer and fewer than four brain metastases treated with stereotactic radiosurgery had better overall survival than did similar patients treated with whole-brain irradiation in a nonrandomized observational study.

The study of 413 patients who were eligible for either treatment showed that the median overall survival was 9.0 months for those treated with stereotactic radiosurgery (SRS) alone, versus 3.9 months for those treated with whole-brain radiation therapy (WBRT) alone, reported Dr. Lia M. Halasz, assistant professor of radiation oncology at the University of Washington in Seattle.

The findings suggest the need for a randomized clinical trial comparing the two treatment strategies in patients with non–small cell lung cancer and up to three brain metastases, she said at the annual meeting of the American Society for Radiation Oncology.

"This observational data may better reflect real-world practice; however, the caveat is that all of these patients were treated at large NCCN [National Comprehensive Cancer Network] institutions, and may not reflect practices all across the United States," she said.

Dr. James B. Yu, a therapeutic radiologist and cancer outcomes researcher at Yale University, New Haven, Conn., commented that the study shows "at the very least, NCCN sites are doing a very good job at selecting patients for radiosurgery." Dr. Yu, the invited discussant, was not involved in the study.

There have been no randomized clinical trials directly comparing SRS alone vs. WBRT alone in patients with newly diagnosed brain metastases, and the optimal treatment for such patients is unknown, Dr. Halasz said. The investigators therefore undertook an observational study to determine whether one strategy had a therapeutic advantage over the other.

They identified 413 patients diagnosed with brain metastases without leptomeningeal disease from an NCCN longitudinal database from November 2006 through January 2010. The patients had all received radiation therapy with no neurosurgical resection within 60 days of diagnosis.

Of this group, 118 (29%) underwent SRS, 295 (71%) had WBRT; and 13 patients (3%) had both as initial treatment.

Patients with three or fewer metastases were significantly more likely to receive SRS than WBRT, whereas those with four or more metastases were more likely to receive WBRT (P less than .001). Other factors associated with choice of SRS were smaller metastases (P = .036) and one or no sites of extracranial disease, compared with two or more (P = .013).

The authors analyzed a subset of 197 patients with fewer than four brain metastases and all metastatic sites smaller than 4 cm, all of whom were eligible for either treatment, and 48% of whom underwent SRS alone. As noted before, the unadjusted overall survival in this group was 9.0 months for the SRS-treated patients, and 3.9 months for those treated with WBRT.

To compensate for patient-selection biases, the authors then performed a propensity score analysis in which they stratified patients by their propensity to receive radiosurgery. In this analysis, the estimated treatment effect of SRS on overall survival was a hazard ratio (HR) of 0.62 (P = .018). Factors significantly associated with overall survival included SRS vs. WBRT, number of brain metastases, extent of extracranial disease, institution, and year of treatment.

In an analysis using a standardized mortality-ratio weighing method, they found that the estimated treatment effect of SRS on overall survival was an HR of 0.67 (P = .007).

Additionally, the authors performed a sensitivity analysis of potential unmeasured confounders, assuming that patients who underwent WBRT were three times more likely to have a Karnofsky performance score less than 70, and that the HR for that poor performance status was 2.13, based on recursive partitioning analysis (RPA) status. In this analysis, the HR favoring SRS was 0.64 (P = .037).

Finally, they performed a companion analysis with breast cancer data, and found a similar HR in favor of SRS (HR, 0.59; P = .036)

The funding source for the study was not reported. Dr. Halasz and Dr. Yu reported having no conflicts of interest to disclose.

ATLANTA – Patients with non–small cell lung cancer and fewer than four brain metastases treated with stereotactic radiosurgery had better overall survival than did similar patients treated with whole-brain irradiation in a nonrandomized observational study.

The study of 413 patients who were eligible for either treatment showed that the median overall survival was 9.0 months for those treated with stereotactic radiosurgery (SRS) alone, versus 3.9 months for those treated with whole-brain radiation therapy (WBRT) alone, reported Dr. Lia M. Halasz, assistant professor of radiation oncology at the University of Washington in Seattle.

The findings suggest the need for a randomized clinical trial comparing the two treatment strategies in patients with non–small cell lung cancer and up to three brain metastases, she said at the annual meeting of the American Society for Radiation Oncology.

"This observational data may better reflect real-world practice; however, the caveat is that all of these patients were treated at large NCCN [National Comprehensive Cancer Network] institutions, and may not reflect practices all across the United States," she said.

Dr. James B. Yu, a therapeutic radiologist and cancer outcomes researcher at Yale University, New Haven, Conn., commented that the study shows "at the very least, NCCN sites are doing a very good job at selecting patients for radiosurgery." Dr. Yu, the invited discussant, was not involved in the study.

There have been no randomized clinical trials directly comparing SRS alone vs. WBRT alone in patients with newly diagnosed brain metastases, and the optimal treatment for such patients is unknown, Dr. Halasz said. The investigators therefore undertook an observational study to determine whether one strategy had a therapeutic advantage over the other.

They identified 413 patients diagnosed with brain metastases without leptomeningeal disease from an NCCN longitudinal database from November 2006 through January 2010. The patients had all received radiation therapy with no neurosurgical resection within 60 days of diagnosis.

Of this group, 118 (29%) underwent SRS, 295 (71%) had WBRT; and 13 patients (3%) had both as initial treatment.

Patients with three or fewer metastases were significantly more likely to receive SRS than WBRT, whereas those with four or more metastases were more likely to receive WBRT (P less than .001). Other factors associated with choice of SRS were smaller metastases (P = .036) and one or no sites of extracranial disease, compared with two or more (P = .013).

The authors analyzed a subset of 197 patients with fewer than four brain metastases and all metastatic sites smaller than 4 cm, all of whom were eligible for either treatment, and 48% of whom underwent SRS alone. As noted before, the unadjusted overall survival in this group was 9.0 months for the SRS-treated patients, and 3.9 months for those treated with WBRT.

To compensate for patient-selection biases, the authors then performed a propensity score analysis in which they stratified patients by their propensity to receive radiosurgery. In this analysis, the estimated treatment effect of SRS on overall survival was a hazard ratio (HR) of 0.62 (P = .018). Factors significantly associated with overall survival included SRS vs. WBRT, number of brain metastases, extent of extracranial disease, institution, and year of treatment.

In an analysis using a standardized mortality-ratio weighing method, they found that the estimated treatment effect of SRS on overall survival was an HR of 0.67 (P = .007).

Additionally, the authors performed a sensitivity analysis of potential unmeasured confounders, assuming that patients who underwent WBRT were three times more likely to have a Karnofsky performance score less than 70, and that the HR for that poor performance status was 2.13, based on recursive partitioning analysis (RPA) status. In this analysis, the HR favoring SRS was 0.64 (P = .037).

Finally, they performed a companion analysis with breast cancer data, and found a similar HR in favor of SRS (HR, 0.59; P = .036)

The funding source for the study was not reported. Dr. Halasz and Dr. Yu reported having no conflicts of interest to disclose.

DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?

Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.

Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.

The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."

Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.

Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."

Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.

Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.

[email protected]

DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?

Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.

Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.

The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."

Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.

Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."

Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.

Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.

[email protected]

DANA POINT, CALIF. – When is someone too young for antiaging procedures with cosmetic fillers or laser resurfacing?

Chronologic age "is somewhat irrelevant," in the opinion of Dr. Elizabeth L. Tanzi, codirector of the Washington (D.C.) Institute of Dermatologic Laser Surgery. "I’m looking at dermatologic age, with a critical evaluation of [a patient’s] need," she said at a meeting sponsored by SkinCare Physicians and Northwestern University.

Dr. Tanzi noted that genetics also plays a role in how each person’s skin ages over time. "Some people have inherited facial expressions," she explained. "They may get hyperdynamic movement in certain parts of their face and develop wrinkles much earlier than you would anticipate. Environmental exposure clearly plays a large role. Excessive ultraviolet exposure, growing up with outdoor sporting activities, tanning bed use, or poor habits such as smoking are going to lead to an accelerated aging process," she said.

The importance of establishing realistic patient expectations starts with the first office consultation, when clinicians emphasize that "we can slow down the signs of aging on your skin, but we cannot stop the process completely," said Dr. Tanzi, who is also an assistant professor of dermatology at George Washington University Medical Center, Washington. "I think it’s more important to talk about looking youthful, energetic, and vibrant, not necessarily looking young, because we may be inadvertently delivering the wrong message – that all aging is preventable if treatments are started early enough – and that sets the stage for unrealistic expectations."

Encouraging sun protection behaviors is sensible, and "most dermatologists realize that you can use neuromodulators and fillers strategically early on," Dr. Tanzi said. "But the idea of using fractionated laser resurfacing treatments to promote improved skin function is intriguing to me. We know we can improve the skin cosmetically through a series of fractional laser resurfacing treatments. But can we functionally improve the skin as it’s aging?" she questioned.

Cutting-edge research suggests that may be the case. In 2012, Dan F. Spandau, Ph.D., and his colleagues (J. Invest. Dermatol. 2012;132:1591-6) published data showing that dermal wounding procedures such as fractional resurfacing can "wake up senescent dermal fibroblasts to produce more insulin-like growth factor-1 (IGF-1), which helps the epidermis ward off the damaging effects of UVB on the skin," Dr. Tanzi said. In that case, she continued, "should we be recommending fractional resurfacing as part of a healthy antiaging routine? If so, at what age? These are exciting developments that need additional research to help guide new treatment protocols."

Although she is enthusiastic about preventing some signs of aging and helping patients maintain a youthful appearance, Dr. Tanzi expressed some concerns. "If we are not careful, we could be setting ourselves up for an expectation of being able to stop the aging process, and this can be a slippery slope, especially for women," she said. "Especially when it comes to fillers and neuromodulators, if not done judiciously they can lead to a very artificial look which, ironically, makes women look much older," Dr. Tanzi said. "As thoughtful physicians, it’s important to keep perspective and guide patients to know when enough is enough [in terms of procedures]," she added.

Dr. Tanzi disclosed that she is a consultant for Cynosure/Palomar, Lumenis, and other companies.

[email protected]

This month’s feature highlights an initiative of the Society of Hospital Medicine aimed at helping hospitalists drive team-based medication reconciliation programs.

Dr. Jeffrey Schnipper, director of clinical research for the hospitalist service at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, both in Boston, discusses the opportunities and challenges of med-rec and why he thinks med-rec shouldn’t be viewed as just a regulatory issue.

Dr. Stephanie Mueller, a clinician investigator and hospitalist researcher at Brigham and Women’s Hospital, talks about how MARQUIS components were developed and the role patients can play in med-rec. Dr. Amanda Salanitro, a hospitalist at the VA Tennessee Valley Healthcare System and an instructor at Vanderbilt University, both in Nashville, shares why she sees accountability as a critical component of med-rec quality improvement and her thoughts about how IT can help the process.

Click hear to listen to our medication reconciliation podcast.

This month’s feature highlights an initiative of the Society of Hospital Medicine aimed at helping hospitalists drive team-based medication reconciliation programs.

Dr. Jeffrey Schnipper, director of clinical research for the hospitalist service at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, both in Boston, discusses the opportunities and challenges of med-rec and why he thinks med-rec shouldn’t be viewed as just a regulatory issue.

Dr. Stephanie Mueller, a clinician investigator and hospitalist researcher at Brigham and Women’s Hospital, talks about how MARQUIS components were developed and the role patients can play in med-rec. Dr. Amanda Salanitro, a hospitalist at the VA Tennessee Valley Healthcare System and an instructor at Vanderbilt University, both in Nashville, shares why she sees accountability as a critical component of med-rec quality improvement and her thoughts about how IT can help the process.

Click hear to listen to our medication reconciliation podcast.

This month’s feature highlights an initiative of the Society of Hospital Medicine aimed at helping hospitalists drive team-based medication reconciliation programs.

Dr. Jeffrey Schnipper, director of clinical research for the hospitalist service at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, both in Boston, discusses the opportunities and challenges of med-rec and why he thinks med-rec shouldn’t be viewed as just a regulatory issue.

Dr. Stephanie Mueller, a clinician investigator and hospitalist researcher at Brigham and Women’s Hospital, talks about how MARQUIS components were developed and the role patients can play in med-rec. Dr. Amanda Salanitro, a hospitalist at the VA Tennessee Valley Healthcare System and an instructor at Vanderbilt University, both in Nashville, shares why she sees accountability as a critical component of med-rec quality improvement and her thoughts about how IT can help the process.

Click hear to listen to our medication reconciliation podcast.

Click here to listen to more of our interview with Paul Roscoe, CEO of the Washington, D.C.-based Advisory Board Company

Click here to listen to more of our interview with Paul Roscoe, CEO of the Washington, D.C.-based Advisory Board Company

Click here to listen to more of our interview with Paul Roscoe, CEO of the Washington, D.C.-based Advisory Board Company

Click here to listen to excerpts of our interview with Dr. Deitelzweig, chair of SHM’s Practice Analysis Committee.

Click here to listen to excerpts of our interview with Dr. Deitelzweig, chair of SHM’s Practice Analysis Committee.

Click here to listen to excerpts of our interview with Dr. Deitelzweig, chair of SHM’s Practice Analysis Committee.

Ensuring data quality and equivalency can present major challenges in data analytics, especially given the field’s dearth of uniform standards.

“The joke is that the great thing about health-care data standards is that there’s so many to choose from,” says Brett Davis, general manager of Deloitte Health Informatics. If data integration remains a big challenge, however, Davis says the cost and complexity of the technology is dropping rapidly.

A lack of electronic health records (EHR) can limit more advanced data-mining functions. But that’s no excuse for not exploring the technology, says Steven Deitelzweig, MD, SFHM, system chairman for hospital medicine at Ochsner Health System in New Orleans and chair of SHM’s Practice Analysis Committee.

Deployment of that partial prerequisite also seems to be happening quickly around the country. The Office of the National Coordinator for Health IT (ONC) estimates that hospital adoption of at least a basic EHR system more than tripled between 2009 and 2012, to 44% from 12%. Meanwhile, an estimated 85% of hospitals were at least in possession of certified EHR technology by 2012.

Despite the falling barriers, Davis cautions that users should have clear goals in mind when setting up a new system. “There is the risk of building bridges to nowhere, where you just integrate data for the sake of integrating data but not knowing what questions and insights you want to glean from it,” he says.

ONC spokesman Peter Ashkenaz agrees, citing governance within a hospital or health center and education of all participants as important elements of any data-analytics plan. Among the questions that must be addressed, he says, are these: “Have we collected the right information? Are we doing so efficiently and securely with respect to privacy requirements? Are we sharing the data with the appropriate parties? Are we doing so in a way that is easily understood? Are we asking the right questions about how to use the information?”

The most fundamental question, Dr. Deitelzweig says, may be whether a hospitalist group, hospital, or health system is truly committed to using the technology. “If you’re going to make the investment in such things, then you really better be dedicated to understanding them and how best to utilize them. And give it some time,” he says. “I think people want solutions fast, and often they don’t take the time to individualize it or customize it.” TH

Bryn Nelson is a freelance medical writer in Seattle.

Ensuring data quality and equivalency can present major challenges in data analytics, especially given the field’s dearth of uniform standards.

“The joke is that the great thing about health-care data standards is that there’s so many to choose from,” says Brett Davis, general manager of Deloitte Health Informatics. If data integration remains a big challenge, however, Davis says the cost and complexity of the technology is dropping rapidly.

A lack of electronic health records (EHR) can limit more advanced data-mining functions. But that’s no excuse for not exploring the technology, says Steven Deitelzweig, MD, SFHM, system chairman for hospital medicine at Ochsner Health System in New Orleans and chair of SHM’s Practice Analysis Committee.

Deployment of that partial prerequisite also seems to be happening quickly around the country. The Office of the National Coordinator for Health IT (ONC) estimates that hospital adoption of at least a basic EHR system more than tripled between 2009 and 2012, to 44% from 12%. Meanwhile, an estimated 85% of hospitals were at least in possession of certified EHR technology by 2012.

Despite the falling barriers, Davis cautions that users should have clear goals in mind when setting up a new system. “There is the risk of building bridges to nowhere, where you just integrate data for the sake of integrating data but not knowing what questions and insights you want to glean from it,” he says.

ONC spokesman Peter Ashkenaz agrees, citing governance within a hospital or health center and education of all participants as important elements of any data-analytics plan. Among the questions that must be addressed, he says, are these: “Have we collected the right information? Are we doing so efficiently and securely with respect to privacy requirements? Are we sharing the data with the appropriate parties? Are we doing so in a way that is easily understood? Are we asking the right questions about how to use the information?”

The most fundamental question, Dr. Deitelzweig says, may be whether a hospitalist group, hospital, or health system is truly committed to using the technology. “If you’re going to make the investment in such things, then you really better be dedicated to understanding them and how best to utilize them. And give it some time,” he says. “I think people want solutions fast, and often they don’t take the time to individualize it or customize it.” TH

Bryn Nelson is a freelance medical writer in Seattle.

Ensuring data quality and equivalency can present major challenges in data analytics, especially given the field’s dearth of uniform standards.

“The joke is that the great thing about health-care data standards is that there’s so many to choose from,” says Brett Davis, general manager of Deloitte Health Informatics. If data integration remains a big challenge, however, Davis says the cost and complexity of the technology is dropping rapidly.

A lack of electronic health records (EHR) can limit more advanced data-mining functions. But that’s no excuse for not exploring the technology, says Steven Deitelzweig, MD, SFHM, system chairman for hospital medicine at Ochsner Health System in New Orleans and chair of SHM’s Practice Analysis Committee.

Deployment of that partial prerequisite also seems to be happening quickly around the country. The Office of the National Coordinator for Health IT (ONC) estimates that hospital adoption of at least a basic EHR system more than tripled between 2009 and 2012, to 44% from 12%. Meanwhile, an estimated 85% of hospitals were at least in possession of certified EHR technology by 2012.

Despite the falling barriers, Davis cautions that users should have clear goals in mind when setting up a new system. “There is the risk of building bridges to nowhere, where you just integrate data for the sake of integrating data but not knowing what questions and insights you want to glean from it,” he says.

ONC spokesman Peter Ashkenaz agrees, citing governance within a hospital or health center and education of all participants as important elements of any data-analytics plan. Among the questions that must be addressed, he says, are these: “Have we collected the right information? Are we doing so efficiently and securely with respect to privacy requirements? Are we sharing the data with the appropriate parties? Are we doing so in a way that is easily understood? Are we asking the right questions about how to use the information?”

The most fundamental question, Dr. Deitelzweig says, may be whether a hospitalist group, hospital, or health system is truly committed to using the technology. “If you’re going to make the investment in such things, then you really better be dedicated to understanding them and how best to utilize them. And give it some time,” he says. “I think people want solutions fast, and often they don’t take the time to individualize it or customize it.” TH

Bryn Nelson is a freelance medical writer in Seattle.

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.¹

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website. TH

Larry Beresford is a freelance writer in San Francisco.

 

Reference

1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.

 

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.¹

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website. TH

Larry Beresford is a freelance writer in San Francisco.

 

Reference

1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.

 

What is the best possible medication history? How is it done? Who should do it? When should it be done during a patient’s journey in and out of the hospital? What medication discrepancies—and potential adverse drug events—are most likely?

Those are questions veteran hospitalist Jason Stein, MD, tried to answer during an HM13 breakout session on medication reconciliation at the Gaylord National Resort and Conference Center in National Harbor, Md.

“How do you know as the discharging provider if the medication list you’re looking at is gold or garbage?” said Dr. Stein, associate director for quality improvement (QI) at Emory University in Atlanta and a mentor for SHM’s Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) quality-research initiative.

The concept of the “best possible medication history” (BPMH) originated with patient-safety expert Edward Etchells, MD, MSc, at Sunnybrook Health Sciences Centre in Toronto. The concept is outlined on a pocket reminder card for MARQUIS participants, explained co-presenter and principal investigator Jeffrey Schnipper MD, MPH, FHM, a hospitalist at Brigham & Women’s Hospital in Boston.

“Sometimes it’s impossible to know what the patient was or wasn’t taking, but it doesn’t mean you don’t do your best,” he said, adding that hospitalists should attempt to get at least one reliable, corroborating source of information for a patient’s medical history.

Sometimes it is necessary to speak to family members or the community pharmacy, Dr. Schnipper said, because many patients can’t remember all of the drugs they are taking. Trying to do medication reconciliation at the time of discharge when BPMH has not been done can lead to more work for the provider, medication errors, or rehospitalizations. Ideally, knowledge of what the patient was taking before admission, as well as the patient’s health literacy and adherence history, should be gathered and documented once, early, and well during the hospitalization by a trained provider, according to Dr. Schnipper.

An SHM survey, however, showed 50% to 70% percent of front-line providers have never received BPMH training, and 60% say they are not given the time.¹

“Not knowing means a diligent provider would need to take a BPMH at discharge, which is a waste,” Dr. Stein said. It would be nice to tell from the electronic health record whether a true BPMH had been taken for every hospitalized patient—or at least every high-risk patient—but this goal is not well-supported by current information technology, MARQUIS investigators said they have learned.

The MARQUIS program was launched in 2011 with a grant from the federal Agency for Healthcare Research and Quality. It began with a thorough review of the literature on medication reconciliation and the development of a toolkit of best practices. In 2012, six pilot sites were offered a menu of 11 MARQUIS medication-reconciliation interventions to choose from and help in implementing them from an SHM mentor, with expertise in both QI and medication safety.

Listen to more of our interview with MARQUIS principal investigator Jeffrey Schnipper, MD, MPH, FHM.

Participating sites have mobilized high-level hospital leadership and utilize a local champion, usually a hospitalist, tools for assessing high-risk patients, medication-reconciliation assistants or counselors, and pharmacist involvement. Different sites have employed different professional staff to take medication histories.

Dr. Schnipper said he expects another round of MARQUIS-mentored implementation, probably in 2014, after data from the first round have been analyzed. The program is tracking such outcomes as the number of potentially harmful, unintentional medication discrepancies per patient at participating sites.

The MARQUIS toolkit is available on the SHM website. TH

Larry Beresford is a freelance writer in San Francisco.

 

Reference

1. Schnipper JL, Mueller SK, Salanitro AH, Stein J. Got Med Wreck? Targeted Repairs from the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS). PowerPoint presentation at Society of Hospital Medicine annual meeting, May 16-19, 2013, National Harbor, Md.