Physician Assessment and Feedback During Quality Circle to Reduce Low-Value Services in Outpatients: a Pre-Post Quality Improvement Study.

The impact of the Choosing Wisely (CW) campaign is debated as recommendations alone may not modify physician behavior. The aim of this study was to assess whether behavioral interventions with physician assessment and feedback during quality circles (QCs) could reduce low-value services. Pre-post quality improvement intervention with a parallel comparison group involving outpatients followed in a Swiss-managed care network, including 700 general physicians (GPs) and 150,000 adult patients. Interventions included performance feedback about low-value activities and comparison with peers during QCs. We assessed individual physician behavior and healthcare use from laboratory and insurance claims files between August 1, 2016, and October 31, 2018. Main outcomes were the change in prescription of three low-value services 6 months before and 6 months after each intervention: measurement of prostate-specific antigen (PSA) and prescription rates of proton pump inhibitors (PPIs) and statins. Among primary care practices, a QC intervention with physician feedback and peer comparison resulted in lower rates of PPI prescription (pre-post mean prescriptions per GP 25.5 ± 23.7 vs 22.9 ± 21.4, p value<0.01; coefficient of variation (Cov) 93.0% vs 91.0%, p=0.49), PSA measurement (6.5 ± 8.7 vs 5.3 ± 6.9 tests per GP, p<0.01; Cov 133.5% vs 130.7%, p=0.84), as well as statins (6.1 ± 6.8 vs 5.6 ± 5.4 prescriptions per GP, p<0.01; Cov 111.5% vs 96.4%, p=0.21). Changes in prescription of low-value services among GPs who did not attend QCs were not statistically significant over this time period. Our results demonstrate a modest but statistically significant effect of QCs with educative feedback in reducing low-value services in outpatients with low impact on coefficient of variation. Limiting overuse in medicine is very challenging and dedicated discussion and real-time review of actionable data may help

assessment in Switzerland – Code of practice for mass movements

Abstract More than 6% of Switzerland is prone to slope instability. New federal regulations require regional authorities (cantons) to generate natural hazard maps and the zoning of mass movements to restrict development on hazard-prone land. The paper discusses the proposed three-step procedure of hazard identification, hazard assessment and risk management. The Codes of Practice concerning the hazard maps involve the standard use of three colours (red, blue and yellow) to indicate areas of prohibited construction, construction with certain safety requirements and construction without restriction. Résumé Plus de 6% du territoire suisse est soumis à des phénomènes d'instabilités de terrain. De nouvelles bases légales exigent des autorités régionales l'établissement de cartes de danger et le zonage pour les mouvements de terrain afin de restreindre le développement dans les zones sensibles. Une procédure en trois étapes comprend l'identification du danger, l'évaluation du danger et la gestion du risque. L'application dans l'aménagement de ces cartes de danger peut être résumée ainsi: dans les zones rouges les constructions sont interdites, dans les zones bleues les constructions sont autorisées lorsque des prescriptions techniques de sécurité sont respectées et dans les zones jaunes les constructions sont autorisées

Schnee, Gletscher und Permafrost 2007/2008: Kryosphärenbericht der Schweizer Alpen

Die wichtigsten Entwicklungen von Schnee, Gletscher und Permafrost in den Schweizer Alpen1 für das hydrologische Jahr 2007/20082 zeigen: Nicht einmal der schneereiche Winter konnte den Rückzug der Schweizer Gletscher bremsen. Der Gornergletscher wurde sogar 290 Meter kürzer. In den Permafrostgebieten führten der schneereiche Winter sowie der warme Sommer zu Temperaturbedingungen wie im letzten Jahrzehnt, und die Blockgletschergeschwindigkeiten haben dabei leicht zugenommen