1. Jacobi Ambulatory Care Service The next steps…

2. Jacobi Ambulatory Care Service Doing More by doing less Tips

3. Jacobi Ambulatory Care Service Where did these tips come from? Developed by the National Physicians Alliance, with a grant from the ABIM Evidence-based, quality-improving, resource-sparing activities that can easily be incorporated into practice An initial list generated by a working group that will be distributed to all NPA members

4. Jacobi Ambulatory Care Service Note on the NPA Founded in 2005 22,000 members belonging to all kinds of specialties Stated goal: ensure affordable high-quality health care for all

5. Jacobi Ambulatory Care Service Tip One Don’t order imaging tests for low back pain within the first six weeks of symptoms unless red flags are present.

6. Jacobi Ambulatory Care Service Tip Two Don’t prescribe antibiotics for mild to moderate sinusitis unless symptoms last for more than seven days or worsen.

7. Jacobi Ambulatory Care Service Tip Three Don’t order ECGs (or any cardiac screening tests) for asymptomatic, low risk patients.

8. Jacobi Ambulatory Care Service Tip Four Don’t do paps on women who are younger than 21 or women who have had a hysterectomy for benign disease

9. Jacobi Ambulatory Care Service Tip Five Don’t screen women under 65 or men under 70 for osteoporosis with DEXAs unless they have risk factors for osteoporosis.

10. Jacobi Ambulatory Care Service Some thoughts about bisphosphonates… The FDA is about to begin a review of the safety of these medications. Side effects of prolonged use (more than five years) may include atypical femoral fractures, osteonecrosis of the jaw, esophageal ulcers, bone fragility, and prolonged fracture healing time. The benefits after five years of use are unclear while the risks probably increase. Optimal age of initiation of this therapy is probably at age 65 or older because this is when the risk of fracture increases.

11. Jacobi Ambulatory Care Service Any tips of your own?