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<p>Colleagues,</p>
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<p>See below. Sitting inside our Epic system are the answers to many clinical questions, if we take the time to search for them! Our dataset is pretty consistent, as compared to Medicaid or group private payer data, driven by practices that we all pretty much
agree upon, and done by like practitioners using the same tools and protocols. And we have thousands of cases of almost everything! <br>
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<p>Dr. Kim is trying to make that system even more data-clean by driving the Epic changes related to SDF, for example. Across the US, more questions are arising as to the best protocol, the fate of SDF'd teeth, etc. and NCH is poised to have a lot of data to
contribute to that discussion. I would encourage us to review her Epic suggestions!!!<br>
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<p>I can only dream about the day when a resident asks me a question and I don't have to say, "I don't know" but rather, "Let's ask Epic."<br>
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<p class="MsoNormal" style="line-height:13.15pt; vertical-align:baseline"><span style="font-size:10.5pt; font-family:""",serif; color:black"><a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__pediatrics.aappublications.org_&d=DwMFAg&c=FGzDrZ8hK6OoO1oc9Smc5l64O0n3B5aByDFzrvN9KLI&r=nog6yQ0eQwWENXE71YHL6eraTU2Rq5ccDVJzImve6uVeMgOgKzXSkghejn9YN12e&m=CW_1cs4m6sZJdq8VyYHk6YRUltdqhGf8E6uZRoIEd00&s=Sy7-a54vC_4G4EWz3ullosK0B7XmNPyJfKxVRXMYZuM&e="><span style="color:#005A96; border:none windowtext 1.0pt; padding:0in; text-decoration:none">Pediatrics</span></a></span></p>
<p class="MsoNormal" style="line-height:13.15pt; vertical-align:baseline"><span style="font-size:10.5pt; font-family:""",serif; color:black">January 2018</span></p>
<p class="MsoNormal" style="margin-top:11.25pt; line-height:27.4pt; vertical-align:baseline">
<span style="font-size:22.5pt; font-family:""",serif; color:#131313; letter-spacing:-.65pt">Choosing Better: Standard of Care Should Be Data-driven, Not Just Habit-forming</span></p>
<p class="MsoNormal" style="vertical-align:baseline"><span style="font-size:15.0pt; font-family:""",serif; color:#444444; border:none windowtext 1.0pt; padding:0in">Lauren LaRue Walker, Ricardo Quinonez</span><span style="font-size:10.5pt; font-family:""",serif; color:black"></span></p>
<p class="MsoNormal" style="line-height:19.55pt; vertical-align:baseline"><span style="font-size:10.5pt; font-family:""",serif; color:black">Two main components drive low-value practices in health care: underuse and
<span style="background:yellow">overuse.</span> Underuse (eg, undervaccination), although important, has received greater focus historically. However, because of the rising costs of health care in the United States and the realization that we can “safely do
less” as pediatricians,</span><sup><span style="font-size:6.5pt; font-family:""",serif; color:black; border:none windowtext 1.0pt; padding:0in">1</span></sup><span style="font-size:10.5pt; font-family:""",serif; color:black"> the equally significant
domain of overuse, or the provision of care in which the harms outweigh the benefits,</span><sup><span style="font-size:6.5pt; font-family:""",serif; color:black; border:none windowtext 1.0pt; padding:0in">2</span></sup><span style="font-size:10.5pt; font-family:""",serif; color:black">
is receiving increasing attention. A quality improvement (QI) expert, Dr Don Berwick, recently cited
<span style="background:yellow">overuse as the “next quality frontier.”</span></span><sup><span style="font-size:6.5pt; font-family:""",serif; color:black; border:none windowtext 1.0pt; padding:0in">3</span></sup><span style="font-size:10.5pt; font-family:""",serif; color:black">
The field of pediatrics is not exempt from overuse. In a limited review, Chua et al</span><sup><span style="font-size:6.5pt; font-family:""",serif; color:black; border:none windowtext 1.0pt; padding:0in">4</span></sup><span style="font-size:10.5pt; font-family:""",serif; color:black">
demonstrated that 1 in 10 commercially insured children are exposed to low-value practices, with an approximate cost of $27 million per year.</span></p>
<p class="MsoNormal" style="line-height:19.55pt; vertical-align:baseline"><span style="font-size:10.5pt; font-family:""",serif; color:black">The commonplace nature of low-value care in pediatrics should prompt pediatricians to familiarize themselves with
the growing call for “deimplementation” in medicine.</span><sup><span style="font-size:6.5pt; font-family:""",serif; color:black; border:none windowtext 1.0pt; padding:0in">5</span></sup><span style="font-size:10.5pt; font-family:""",serif; color:black">
Deimplementation refers to the <span style="background:yellow">science of abandoning and unlearning practices built on the scaffolding of habit</span>. Prasad and Ioannidis,</span><sup><span style="font-size:6.5pt; font-family:""",serif; color:black; border:none windowtext 1.0pt; padding:0in">5</span></sup><span style="font-size:10.5pt; font-family:""",serif; color:black">
both experts in the fields of overuse and evidence-based medicine, classify efforts ripe for deimplementation into 3 categories: practices that are novel but yet not fully tested, unproven practices …
</span></p>
<p class="MsoNormal" style="line-height:19.55pt; vertical-align:baseline"><span style="font-size:10.5pt; font-family:""",serif; color:black">Address correspondence to Lauren LaRue Walker, MD, Department of Pediatrics, Section of Pediatric Hospital Medicine,
Baylor College of Medicine, Texas Children’s Hospital, 1102 Bates St, Suite 1860, Houston, TX 77030. E-mail:
<span style="border:none windowtext 1.0pt; padding:0in"><a href="mailto:llwalker@texaschildrens.org"><span style="color:#005A96; text-decoration:none">llwalker@texaschildrens.org</span></a></span></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt; font-family:"Arial",sans-serif"> </span></p>
<p class="MsoNormal">Professor Emeritus</p>
<p class="MsoNormal">U of Iowa</p>
<p class="MsoNormal">Iowa City, IA 52242</p>
<p class="MsoNormal">Arthur-nowak@uiowa.edu</p>
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