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Reply to Weber: Treatment Decisions for Unrepresented Patients: American Thoracic Society/American Geriatrics Society Policy Statement Lacks Sufficient Guidance.

ABSTRACT:

SUBMITTER: Pope TM

PROVIDER: S-EPMC7667911 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Reply to Weber: Treatment Decisions for Unrepresented Patients: American Thoracic Society/American Geriatrics Society Policy Statement Lacks Sufficient Guidance.

Pope Thaddeus M TM Cederquist Lynette L Goodman-Crews Paula P White Douglas B DB

American journal of respiratory and critical care medicine 20201101 10

PMID: 32805136

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Project description:ImportanceThe extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood.ObjectiveTo examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults.DesignRetrospective analysis of overall means and clinician-level variation in performance on three new measures.SubjectsAdults aged 65 years and older who had office visits with outpatient primary or immediate care clinicians within a single academic medical center health system between July 1, 2016, and June 30, 2017.MeasuresTwo electronic clinical quality measures representing potentially inappropriate use of medical services in older adults: prostate-specific antigen testing against guidelines (PSA) in men aged 76 and older; urinalysis or urine culture for non-specific reasons in women aged 65 and older; and one intermediate outcome measure: hemoglobin A1c less than 7.0 in adults aged 75 and older with diabetes mellitus treated with insulin or oral hypoglycemic medication.ResultsSixty-nine clinicians and 2009 patients contributed observations to the PSA measure, 144 clinicians and 5933 patients contributed to the urinalysis/urine culture measure, and 42 clinicians and 665 patients contributed to the diabetes measure. Meaningful clinician-level performance variation was greatest for the PSA measure (intraclass correlation coefficient [ICC] = 0.27), followed by the urinalysis/urine culture measure (ICC = 0.18), and the diabetes measure (ICC = 0.024). The range of possible overuse across clinician quartiles was 8-54% for the PSA measure, 3-35% for the urinalysis/urine culture measure, and 13-49% for the diabetes measure. The odds ratios of overuse in the highest quartile compared with the lowest for the PSA, urinalysis/urine culture, and diabetes measures were 99.3 (95% CI 43 to 228), 15.7 (10 to 24), and 6.0 (3.3 to 11), respectively.ConclusionsWithin the same health system, rates of potential overuse in elderly patients varied greatly across clinicians, particularly for the process measures examined.

Project description:Rationale: Workplace inhalational hazards remain common worldwide, even though they are ameliorable. Previous American Thoracic Society documents have assessed the contribution of workplace exposures to asthma and chronic obstructive pulmonary disease on a population level, but not to other chronic respiratory diseases. The goal of this document is to report an in-depth literature review and data synthesis of the occupational contribution to the burden of the major nonmalignant respiratory diseases, including airway diseases; interstitial fibrosis; hypersensitivity pneumonitis; other noninfectious granulomatous lung diseases, including sarcoidosis; and selected respiratory infections. Methods: Relevant literature was identified for each respiratory condition. The occupational population attributable fraction (PAF) was estimated for those conditions for which there were sufficient population-based studies to allow pooled estimates. For the other conditions, the occupational burden of disease was estimated on the basis of attribution in case series, incidence rate ratios, or attributable fraction within an exposed group. Results: Workplace exposures contribute substantially to the burden of multiple chronic respiratory diseases, including asthma (PAF, 16%); chronic obstructive pulmonary disease (PAF, 14%); chronic bronchitis (PAF, 13%); idiopathic pulmonary fibrosis (PAF, 26%); hypersensitivity pneumonitis (occupational burden, 19%); other granulomatous diseases, including sarcoidosis (occupational burden, 30%); pulmonary alveolar proteinosis (occupational burden, 29%); tuberculosis (occupational burden, 2.3% in silica-exposed workers and 1% in healthcare workers); and community-acquired pneumonia in working-age adults (PAF, 10%). Conclusions: Workplace exposures contribute to the burden of disease across a range of nonmalignant lung conditions in adults (in addition to the 100% burden for the classic occupational pneumoconioses). This burden has important clinical, research, and policy implications. There is a pressing need to improve clinical recognition and public health awareness of the contribution of occupational factors across a range of nonmalignant respiratory diseases.

Dataset Information

Reply to Weber: Treatment Decisions for Unrepresented Patients: American Thoracic Society/American Geriatrics Society Policy Statement Lacks Sufficient Guidance.

Publications

Reply to Weber: Treatment Decisions for Unrepresented Patients: American Thoracic Society/American Geriatrics Society Policy Statement Lacks Sufficient Guidance.

Similar Datasets

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