Records

The 21st Century Cures Act requires that patients be allowed to see their medical records including visit notes beginning November 2. To facilitate that process, the Medicare program has developed this online decision support tool. James W. Mold, MD, MPH

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HYPERVENTILATION SYNDROME: WHY IS IT REGULARLY OVERLOOKED?

Brian Desmarais — Tue, 11 Aug 2020 16:44:08 +0000

Date Added:

August 11, 2020

Journal/Publication:

The American Journal of Medicine

Publication Date:

August 9, 2020

URL:

HYPERVENTILATION SYNDROME: WHY IS IT REGULARLY OVERLOOKED?

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1016/j.amjmed.2020.07.006

MeSH

A short, case-based review of the diagnosis and management of hyperventilation syndrome, an extremely common cause of nonspecific “dizziness.” James W. Mold, MD, MPH

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Electronic form for submission of COVID-19 specimens to the Public Health Lab

Brian Desmarais — Mon, 16 Mar 2020 14:23:01 +0000

Date Added:

March 16, 2020

Journal/Publication:

Oklahoma Department of Health, Public Health Laboratory

Publication Date:

March 16, 2020

URL:

Electronic form for submission of COVID-19 specimens to the Public Health Lab

Type:

Public Health Announcements

Format:

Web Page

Keywords

COVID-19

electronic form

specimens

MeSH

severe acute respiratory syndrome coronavirus 2

public health

Records

This is the electronic fillable form for submission of COVID-19 specimens to the Public Health Lab at the OSDH. James W. Mold, MD, MPH

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Canadian practice guidelines for the treatment of children and adolescents with eating disorders

Brian Desmarais — Tue, 10 Mar 2020 16:04:09 +0000

Date Added:

March 10, 2020

Journal/Publication:

Journal of Eating Disorders

Publication Date:

February 8, 2020

Volume:

URL:

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

Type:

Practice Management Reviews and Guidelines

Format:

Article

DOI (1):

10.1186/s40337-020-0277-8

Keywords

Anorexia nervosa

Avoidant/restrictive food intake disorder

Bulimia nervosa

guidelines

MeSH

Feeding and Eating Disorders

This is a 2020 evidence-based guideline from Canada on management of eating disorders in children and adolescents. It is long and comprehensive. (Potentially useful as a reference when you have a child with an apparent eating disorder.) James W. Mold, MD, MPH

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Abstract
Objectives: Eating disorders are common and serious conditions affecting up to 4% of the population. The
mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no
Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to
which treatment they should use. Our objective was to produce such a guideline.
Methods: Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation
(GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high
quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders.
Results: Strong recommendations were supported specifically in favour of Family-Based Treatment, and more
generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family
Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical
antipsychotics were confirmed.
Conclusions: Several gaps for future work were identified including enhanced research efforts on new primary and
adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
Keywords: Guidelines, Adolescent, Anorexia nervosa, Bulimia nervosa, Avoidant/restrictive food intake disorder

Author/s:

Couturier, J., Isserlin, L., Norris, M., Spettigue, W., Brouwers, M., Kimber, M., McVey, G., Webb, C., Findlay, S., Bhatnagar, N., Snelgrove, N., Ritsma, A., Preskow, W.

Continuation of Annual Screening Mammography and Breast Cancer Mortality in Women Older Than 70 Years

Brian Desmarais — Tue, 25 Feb 2020 15:27:32 +0000

Date Added:

February 25, 2020

Journal/Publication:

Annals of Internal Medicine

Publication Date:

February 25, 2020

URL:

Continuation of Annual Screening Mammography and Breast Cancer Mortality in Women Older Than 70 Years

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.7326/M18-1199

Keywords

MeSH

early detection of cancer

Rare Diseases

Records

Evidence from a large cohort study that annual mammography beyond age 70 does not reduce breast cancer mortality. James W. Mold, MD, MPH

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BACKGROUND:

Randomized trials have shown that initiating breast cancer screening between ages 50 and 69 years and continuing it for 10 years decreases breast cancer mortality. However, no trials have studied whether or when women can safely stop screening mammography. An estimated 52% of women aged 75 years or older undergo screening mammography in the United States.

OBJECTIVE:

To estimate the effect of breast cancer screening on breast cancer mortality in Medicare beneficiaries aged 70 to 84 years.

DESIGN:

Large-scale, population-based, observational study of 2 screening strategies: continuing annual mammography, and stopping screening.

SETTING:

U.S. Medicare program, 2000 to 2008.

PARTICIPANTS:

1 058 013 beneficiaries aged 70 to 84 years who had a life expectancy of at least 10 years, had no previous breast cancer diagnosis, and underwent screening mammography.

MEASUREMENTS:

Eight-year breast cancer mortality, incidence, and treatments, plus the positive predictive value of screening mammography by age group.

RESULTS:

In women aged 70 to 74 years, the estimated difference in 8-year risk for breast cancer death between continuing and stopping screening was -1.0 (95% CI, -2.3 to 0.1) death per 1000 women (hazard ratio, 0.78 [CI, 0.63 to 0.95]) (a negative risk difference favors continuing). In those aged 75 to 84 years, the corresponding risk difference was 0.07 (CI, -0.93 to 1.3) death per 1000 women (hazard ratio, 1.00 [CI, 0.83 to 1.19]).

LIMITATIONS:

The available Medicare data permit only 8 years of follow-up after screening. As with any study using observational data, the estimates could be affected by residual confounding.

CONCLUSION:

Continuing annual breast cancer screening past age 75 years did not result in substantial reductions in 8-year breast cancer mortality compared with stopping screening.

PRIMARY FUNDING SOURCE:

National Institutes of Health.

Author/s:

García-Albéniz, X., Hernán, M.A., Logan, R.W., Price, M., Armstrong, K., Hsu, J.

The 2020 Medicare Documentation, Coding, and Payment Update

Brian Desmarais — Fri, 03 Jan 2020 19:58:25 +0000

Date Added:

January 3, 2020

Journal/Publication:

Mayo

Publisher:

American Academy of Family Physicians

Publication Date:

December 12, 2019

URL:

The 2020 Medicare Documentation, Coding, and Payment Update

Type:

Practice Management Reviews and Guidelines

Format:

Article

Keywords

coding

MeSH

Centers for Medicare and Medicaid Services, U.S.

referral and consultation

abdominal pain

Records

Major changes in coding will occur in 2021, but this 2020 update is also important. James W. Mold, MD, MPH

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As usual, the new year brings changes in how doctors bill and get paid for the services they provide to Medicare patients. The reforms that will most affect family physicians’ pay aren’t coming until 2021, when several changes in evaluation and management (E/M) coding and payment are projected to result in a 12% increase for family medicine.1 But there are still a host of things family physicians should know for 2020, including new codes to help you get paid for interacting with patients via the internet and new codes that should help make chronic care management (CCM) more financially rewarding. The Centers for Medicare & Medicaid Services (CMS) is also continuing its quest to streamline documentation requirements and develop new payment models intended to reward quality instead of volume. This article summarizes the 2020 changes most relevant to family medicine. As always, private payers’ policies may differ, so consult with your billing staff to understand any important differences.

Author/s:

Moore, K., Mullins, A., Solis, E.

Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation

John Bayhi — Thu, 02 Jan 2020 21:06:56 +0000

Date Added:

January 2, 2020

Journal/Publication:

Addiction Science & Clinical Practice

Publisher:

BioMed Central Ltd

Publication Date:

December 27, 2019

Issue:

Volume:

URL:

Building a Group-Based Opioid Treatment (GBOT) blueprint: a qualitative study delineating GBOT implementation

Type:

Practice Management Research Results

Format:

Article

DOI (1):

10.1186/s13722-019-0176-y

Keywords

Buprenorphine-naloxone

GBOT

Group psychotherapy

Group visit

Implementation science

Shared medical appointment

Group-Based Opioid Treatment

PMID (1):

31882001

MeSH

Humans

Focus Groups

Patient Participation

outpatients

motivation

opioid-related disorders

This article could be helpful to medical directors, practice facilitators, and QI managers who are tasked with creating systems for addressing patients with opioid use disorders. James W. Mold, MD, MPH

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BACKGROUND:

Group-Based Opioid Treatment (GBOT) has recently emerged as a mechanism for treating patients with opioid use disorder (OUD) in the outpatient setting. However, the more practical "how to" components of successfully delivering GBOT has received little attention in the medical literature, potentially limiting its widespread implementation and utilization. Building on a previous case series, this paper delineates the key components to implementing GBOT by asking: (a) What are the core components to GBOT implementation, and how are they defined? (b) What are the malleable components to GBOT implementation, and what conceptual framework should providers use in determining how to apply these components for effective delivery in their unique clinical environment?

METHODS:

To create a blueprint delineating GBOT implementation, we integrated findings from a previously conducted and separately published systematic review of existing GBOT studies, conducted additional literature review, reviewed best practice recommendations and policies related to GBOT and organizational frameworks for implementing health systems change. We triangulated this data with a qualitative thematic analysis from 5 individual interviews and 2 focus groups representing leaders from 5 different GBOT programs across our institution to identify the key components to GBOT implementation, distinguish "core" and "malleable" components, and provide a conceptual framework for considering various options for implementing the malleable components.

RESULTS:

We identified 6 core components to GBOT implementation that optimize clinical outcomes, comply with mandatory policies and regulations, ensure patient and staff safety, and promote sustainability in delivery. These included consistent group expectations, team-based approach to care, safe and confidential space, billing compliance, regular monitoring, and regular patient participation. We identified 14 malleable components and developed a novel conceptual framework that providers can apply when deciding how to employ each malleable component that considers empirical, theoretical and practical dimensions.

CONCLUSION:

While further research on the effectiveness of GBOT and its individual implementation components is needed, the blueprint outlined here provides an initial framework to help office-based opioid treatment sites implement a successful GBOT approach and hence potentially serve as future study sites to establish efficacy of the model. This blueprint can also be used to continuously monitor how components of GBOT influence treatment outcomes, providing an empirical framework for the ongoing process of refining implementation strategies.

Author/s:

Sokol, R, Albanese, M, Chew, A, Early, J, Grossman, E, Roll, D, Sawin, G, Wu, DJ, Schuman-Olivier, Z