February 2020, Volume XXXIIi, No 11
Learning health systems
Bridging the gap between research and practice
More than one-fifth of all medical care may be unnecessary, according to a 2017 article in Health Affairs by Jason Buxbaum and colleagues. This low-value care—that is, patient care with no net benefit in specific clinical scenarios—costs patients, purchasers, and taxpayers hundreds of billions of dollars every year.
February 2020, Volume XXXIIi, No 11
interview
Advocating for older adults
Rajean Moone, PHD, LNHA, FGSA
Minnesota Leadership Council on Aging
Learning health systems: Bridging the gap between research and practice
By Timothy Beebe, PhD
More than one-fifth of all medical care may be unnecessary, according to a 2017 article in Health Affairs by Jason Buxbaum and colleagues. This low-value care—that is, patient care with no net benefit in specific clinical scenarios—costs patients, purchasers, and taxpayers hundreds of billions of dollars every year. The United States spends more on health care per capita than any of the world’s wealthiest countries, comprising 18% of the U.S. gross domestic product in 2017.
cover story two
Adverse medical outcomes: Creating a principled response
By Marissa K. Linden, JD, and Ruth E. Flynn, JD
Academic medical centers—along with private health care practices—require a comprehensive strategy to deal with potential adverse medical outcomes, one that is tailored to meet their unique needs and cultures. Some large institutions rely on comprehensive legal advice to develop and implement these strategies, but small practices could also benefit from the lessons learned from academia and the law firms that represent them—and should consider the principles detailed in this article.
Medicine and the Law
Physician employment contracts: Legislating noncompete provisions
By Antonio “Tony” Fricano, JD
The utility of a physician noncompete provision in a contract may look much different depending on the perspective of the viewer. On the one hand, we may have a physician two years out of residency who is terminated without cause and now will be forced to relocate because the noncompete provision effectively restricts the ability to practice in the same geographic region.
Sidebar: The noncompete bill: Addressing one inequity
By Sen. Jim Abeler, DC
Noncompete contracts. They have been around for a long time. Now even fast food restaurants use them to keep employees from working for the competition. If you’re in a low-paying job, a noncompete clause seems inherently unfair. But what about doctors? Noncompete clauses make sense for them too, don’t they? After all, if you go to work for a health care system or a system/insurer, you shouldn’t be able to just quit and continue treating the patients who want to stay with you. Is that fair? Maybe the real question is, fair to whom?
Glioblastoma: Activating an immune response
By Clark C. Chen, MD, PhD
Glioblastoma is the most common form of brain cancer in adults, with some 14,000 cases diagnosed each year in the United States. It is also among the most deadly of human cancers. Most patients afflicted with glioblastoma die within two years of diagnosis. Famous individuals have suffered from this disease in recent years. Sen. Edward Kennedy died of glioblastoma in 2009.
Legislation
The Elder Care and Vulnerable Adult Protection Act: Ensuring the safety of older Minnesotans
By Rep. Jennifer Schultz
In 2019 the Minnesota Legislature and Gov. Tim Walz passed bipartisan legislation, the Elder Care and Vulnerable Adult Protection Act, to license assisted living facilities and enact elder care protections. Many stakeholders, including advocates for older adults and providers, united after spending over 100 hours negotiating bill language.
Neurodevelopmental disabilities: Supporting children and families
By Andy Barnes, MD, MPH, FAAP, and Beth Fondell
Neurodevelopmental disabilities (NDDs) are a group of disorders that are often first detected and diagnosed in childhood. Associated primarily with the functioning of the neurological system and brain, they may affect the steady development of emotions, motor skills, learning abilities, self-control, and memory. Three or more of these factors in a young child typically characterize diagnosis of an NDD.
Behavioral Health
Gambling disorder: Diagnosing the “hidden addiction”
When you meet with a patient, the topic of addiction is not typically top-of-mind. And on the rare occasions when you suspect that an addiction is playing a role in your patient’s condition, you’re probably thinking about drug or alcohol addiction. However, other, less obvious addictions can be causing distress and poor health. One such lesser-known addiction is gambling disorder.
Public Health
Reducing Native American opioid deaths: Culture-based research
North America is struggling through an opioid overdose epidemic that has cut across all dividing lines: race, gender, age, socioeconomic status, and culture. Native American Nations suffer this grief and loss along with all other American communities. It is no secret that the Minnesota Native American drug overdose death rate in recent years is six times higher than the state’s overall average.
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