WIHI - A Podcast from the Institute for Healthcare Improvement

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Half of all heart attacks and strokes occur among those with normal cholesterol levels and 15-20% occur among those with no major risk factors at all. The major breakthroughs in understanding cardiovascular disease over the past decade include insights about inflammation and genetics. Each of these can easily be ascertained with either a simple blood test (hsCRP for inflamamtion) or a simple question about parental history of Myocardial Infarction. By incorporating these two new measures into how we think about risk, a new risk tool was derived known as the "Reynolds Risk Score". This is a win-win for everyone as it allows us to better target therapies, avoid toxicity, and improve overall prevention strategies for heart disease.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Screening for falls is as simple as asking the patient if she's fallen in the past year. For patients who have not fallen, ask about gait or balance problems (e.g. "Do you have a walking or balance problem?"). Most older patients who have a history of falls in the past year, or a gait/balance problem, have at least a 50% chance of falling in the coming year. You may want to do a more thorough evaluation on these patients. To make screening easy for new patients, add into your pre-visit questionnaire questions that ask about a history of falls and/or gait/balance problems. Or, have your office staff ask these questions routinely when patients are being checked in.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

The long term use of alendronate for up to 10 years is safe. Those who discontinued treatment at 5 years lost bone mass compared to those who continued but the bone loss was only moderate. Rates of fracture were similar among those who continued verses those who discontinued except for clinical vertebral fractures which, although relatively uncommon, were higher in those who discontinued treatment. Results suggest that after 5 years of alendronate, many women may discontinue therapy for up to 5 years. Although, those at high risk of clinical vertebral fracture may benefit by continuing.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick's latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Which way forward for the quality improvement and patient safety movements? Join IHI's President and CEO, Donald Berwick, for a series of conversations with Senior Communications Strategist, Madge Kaplan. Each monthly installment offers Dr. Berwick?s latest thinking on the major issues of the day and how health care professionals, health care leaders, and patients and families can bring about significant reform.

Most cancer screening guidelines do not recommend screening elderly persons in poor health who have limited life expectancies because the harms of screening (which occur immediately) outweigh the potential benefits (which occur many years in the future). PSA screening rates among elderly men with limited life expectancies should be much lower than current practice to avoid harming these men with unnecessary tests and procedures. Guidelines should be more explicit about how life expectancy is defined and provide tools to help clinicians identify men with poor prognoses who are most likely to be harmed by PSA screening, considering both age and the presence of severe disease.

For the general population, the health benefits of fish intake far outweigh the risks. Women of childbearing age, nursing mothers and young children should eat up to two servings of fish per week as the benefits of fish intake still outweigh the risks. Given the magnitude of the benefits, physicians should regularly give dietary advice to patients for cardiovascular disease prevention.