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Private Equity and Physician Medical Practices — Navigating a Changing Ecosystem
In recent years, private-equity firms have emerged as influential players in the health care market, offering a lifeline to smaller groups needing a competitive edge. The growth of private-equity investment has generated intense interest in potential adverse effects.
Journal Article
A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices
To identify medical practices that offer no net benefits.
We reviewed all original articles published in 10 years (2001-2010) in one high-impact journal. Articles were classified on the basis of whether they addressed a medical practice, whether they tested a new or existing therapy, and whether results were positive or negative. Articles were then classified as 1 of 4 types: replacement, when a new practice surpasses standard of care; back to the drawing board, when a new practice is no better than current practice; reaffirmation, when an existing practice is found to be better than a lesser standard; and reversal, when an existing practice is found to be no better than a lesser therapy. This study was conducted from August 1, 2011, through October 31, 2012.
We reviewed 2044 original articles, 1344 of which concerned a medical practice. Of these, 981 articles (73.0%) examined a new medical practice, whereas 363 (27.0%) tested an established practice. A total of 947 studies (70.5%) had positive findings, whereas 397 (29.5%) reached a negative conclusion. A total of 756 articles addressing a medical practice constituted replacement, 165 were back to the drawing board, 146 were medical reversals, 138 were reaffirmations, and 139 were inconclusive. Of the 363 articles testing standard of care, 146 (40.2%) reversed that practice, whereas 138 (38.0%) reaffirmed it.
The reversal of established medical practice is common and occurs across all classes of medical practice. This investigation sheds light on low-value practices and patterns of medical research.
Journal Article
Data-driven design and construction : 25 strategies for capturing, analyzing and applying building data
\"\"In this comprehensive book, Professor Randy Deutsch has unlocked and laid bare the twenty-first century codice nascosto of architecture. It is data. Big data. Data as driver.This book offers us the chance to become informed and knowledgeable pursuers of data and the opportunities it offers to making architecture a wonderful, useful, and smart art form.\" --From the Foreword by James Timberlake, FAIA Written for architects, engineers, contractors, owners, and educators, and based on today's technology and practices, Data-Driven Design and Construction: 25 Strategies for Capturing, Applying and Analyzing Building Data addresses how innovative individuals and firms are using data to remain competitive while advancing their practices. seeks to address and rectify a gap in our learning, by explaining to architects, engineers, contractors and owners--and students of these fields--how to acquire and use data to make more informed decisions. documents how data-driven design is the new frontier of the convergence between BIM and architectural computational analyses and associated tools. is a book of adaptable strategies you and your organization can apply today to make the most of the data you have at your fingertips. Data-Driven Design and Construction was written to help design practitioners and their project teams make better use of BIM, and leverage data throughout the building lifecycle\"-- Provided by publisher.
Book
Psychiatry beyond the current paradigm
A series of editorials in this Journal have argued that psychiatry is in the midst of a crisis. The various solutions proposed would all involve a strengthening of psychiatry's identity as essentially ‘applied neuroscience’. Although not discounting the importance of the brain sciences and psychopharmacology, we argue that psychiatry needs to move beyond the dominance of the current, technological paradigm. This would be more in keeping with the evidence about how positive outcomes are achieved and could also serve to foster more meaningful collaboration with the growing service user movement.
Journal Article
Professionalism in mental healthcare : experts, expertise and expectations
\"In mental health, as in other medical disciplines, the role of the professional is changing. The availability of information, enhanced roles of other healthcare professionals and changes in training have altered the doctor-patient relationship and left professionals accountable to the needs of clients, politicians, policy makers and funding agencies. This book seeks to redefine the professional role of the specialist mental health worker by bringing perspectives from leading experts from both developed and developing countries, and also from a wide range of professionals in the field of law, medical ethics, education and medical leadership. Uniquely, it also looks at the views of patients and next-generation psychiatrists. It will be of interest to those involved in providing mental healthcare as well as those responsible for health policy initiatives and training\"--Provided by publisher.
Book
Reinvigorating stagnant science: implementation laboratories and a meta-laboratory to efficiently advance the science of audit and feedback
Audit and feedback (A&F) is a commonly used quality improvement (QI) approach. A Cochrane review indicates that A&F is generally effective and leads to modest improvements in professional practice but with considerable variation in the observed effects. While we have some understanding of factors that enhance the effects of A&F, further research needs to explore when A&F is most likely to be effective and how to optimise it. To do this, we need to move away from two-arm trials of A&F compared with control in favour of head-to-head trials of different ways of providing A&F. This paper describes implementation laboratories involving collaborations between healthcare organisations providing A&F at scale, and researchers, to embed head-to-head trials into routine QI programmes. This can improve effectiveness while producing generalisable knowledge about how to optimise A&F. We also describe an international meta-laboratory that aims to maximise cross-laboratory learning and facilitate coordination of A&F research.
Journal Article
A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice
Background
Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive, integrated checklist of determinants of practice (the TICD checklist).
Methods
We performed a systematic review of frameworks of determinants of practice followed by a consensus process. We searched electronic databases and screened the reference lists of key background documents. Two authors independently assessed titles and abstracts, and potentially relevant full text articles. We compiled a list of attributes that a checklist should have: comprehensiveness, relevance, applicability, simplicity, logic, clarity, usability, suitability, and usefulness. We assessed included articles using these criteria and collected information about the theory, model, or logic underlying how the factors (determinants) were selected, described, and grouped, the strengths and weaknesses of the checklist, and the determinants and the domains in each checklist. We drafted a preliminary checklist based on an aggregated list of determinants from the included checklists, and finalized the checklist by a consensus process among implementation researchers.
Results
We screened 5,778 titles and abstracts and retrieved 87 potentially relevant papers in full text. Several of these papers had references to papers that we also retrieved in full text. We also checked potentially relevant papers we had on file that were not retrieved by the searches. We included 12 checklists. None of these were completely comprehensive when compared to the aggregated list of determinants and domains. We developed a checklist with 57 potential determinants of practice grouped in seven domains: guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources, capacity for organisational change, and social, political, and legal factors. We also developed five worksheets to facilitate the use of the checklist.
Conclusions
Based on a systematic review and a consensus process we developed a checklist that aims to be comprehensive and to build on the strengths of each of the 12 included checklists. The checklist is accompanied with five worksheets to facilitate its use in implementation research and quality improvement projects.
Journal Article