Assignments Week 2

Syllabus

Monday	Tuesday	Wednesday	Thursday	Friday
VBHC: Mod 4 (1˚10')	Class (2 hrs)	VBHC: Mod 5 (1˚)	Class (2 hrs)	Mini-Reflection
Mini-Pres*: PCMH vs IPU		Intro to Choosing Wisely * (2˚)	Click here for May 2020 recorded talk with Dr. Alice Ma	ACP: Eliminate Healthcare Waste (30')
Peruse "WellMed" website, TeamSTEPPS (15')		CW Society Guidelines: American Society of Hematology	Learn more about the FWGBD
"Overkill" by Atul Gawande (1˚) (PDF below)		CW Society Guidelines: American Society of Hematology-American Society of Pediatric Heme/Onc	Read about another affiliate clinic (PDF below)
"The Strategy that will Fix Healthcare" (1˚) (PDF below)
"What the Healthcare Debate Still Gets Wrong" (45')
Opt: Reflecting on Hotspotting and Value Stewardship

Required Readings (PDFs)

2MB

OverKill - Atul Gawande.pdf

pdf

Monday Reading 1

218KB

The Strategy That Will Fix Health Care.pdf

pdf

Monday Reading 2

Further Instructions & Resources:

• Mini-Pres: PCMH vs. IPU

  • All students (1˚): Please read the articles below and be prepared to discuss tomorrow. (Note: these are extra resources in the Dell Modules)

    • American Medical Home Runs (30')

    • IPU, Part 1 (10')

    • IPU, Part 2 (10')

  • Student Discussion Leaders (2˚): You will be leading a short class discussion on PCMH vs IPUs. The articles in the Dell Modules are a few years behind, so you are tasked with finding updated information on these models. We have included some articles as a jumping off point and expect you to look for additional articles to prepare yourself to lead a discussion. To assist you, the course leaders can distribute some discussion questions to asked of the class.

    • Association of High-Cost Health Care Utilization with Longitudinal Changes in PCMH Implementation (20')

    • The PCMH: Expensive and in Need of Repair (5')

    • 2013 Review on PCMH (30')

    • 2017 Evaluation of PCMHs (20')

    • American College of Physicians, page on PCMHs (10')

    • 2017 RCT on IPU (30')

• Opt: Reflecting on Hotspotting and Value Stewardship

  • Optionally review the two other Atul Gawande pieces mentioned (and heavily critiqued) in the article, What the Healthcare Debate Still Gets Wrong. Facilitators can choose to assign all or some of these articles and decide whether to compare/contrast the arguments made by Gawande vs. Gaffney. Essentially, Gawande's articles discuss how "overdiagnosis and overtesting" (argued in OverKill & Cost Conundrum) and "super utilizers," (argued in The Hot Spotters) are huge contributors to healthcare waste and gross overspending in the U.S. whereas Gaffney, in review of Uwe Reinhardt's book, suggests that healthcare pricing and policy are principally responsible. By the way, a recent NYT piece (also included) highlights how recent research into hotspotting programs shows they are not as effective at reducing healthcare costs as everyone hoped.

1MB

The Cost Conundrum _ The New Yorker.pdf

pdf

Cost Conundrum

3MB

Finding Medicine’s Hot Spots _ The New Yorker.pdf

pdf

Hotspotters - Who are the Pts?

5MB

These Patients Are Hard to Treat - The New York Times.pdf

pdf

Hotspotting

• Intro to the Choosing Wisely campaign:

  • Facilitators can decide which society guidelines to recommend to students. In the May 2020 elective's Thursday discussion section, UNC students heard from Dr. Alice Ma (renowned hematologist), so we chose hematology society guidelines (also because she contributed to their development). In her talk, she discussed the innovative, IPU-like Bleeding Disorders clinic that she helps run at UNC. It is an affiliate clinic with the Foundation for Women & Girls with Bleeding Disorders, and multiple institutions across the country boast such institutions. Further reading has been provided, as well as the link to Dr. Ma's talk.

587KB

Multidiscp. Bleeding Disorders Clinic.pdf

pdf

More info on Bleeding Disorders Clinics