Adolescent idiopathic scoliosis (AIS) is traditionally defined as a lateral curvature of the spine of 10° or more in persons aged 10 to 18 years that is not a result of an underlying condition (a glossary of terms appears in the Box). It is the most common form of scoliosis^9- 11 and occurs more commonly in females.^12,13 Estimates from screening studies dating from 1985 to 2011 suggest that the prevalence of AIS ranges from 0.5% to 5.2%.^6,12 Because two-thirds of patients with AIS experience curve progression during adolescence¹⁴ and progression into adulthood is more likely in those with curves greater than 40° at the end of growth,^15- 18 treatment is focused on slowing curve progression before skeletal maturity. Patients with AIS who have mild curves do not appear to have clinically important symptoms during adolescence, but large curves may be associated with adverse long-term health outcomes in later adulthood, including an increased risk for shortness of breath with curves greater than 50°, diminished lung volumes with curves greater than 70°, and more impaired pulmonary function with curves greater than 100°.¹⁷

From JAMA — Screening for Skin Cancer in Adults — Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Quiz Ref ID Elevations in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) are precursors to atherosclerosis and coronary heart disease. Identifying and treating dyslipidemia in adults older than 40 years is common clinical practice in the United States.¹ Total cholesterol and LDL-C concentrations in healthy children vary with age: they are low at birth, increase until age 2 years, peak before puberty, decrease during adolescence, and increase again during late adolescence and young adulthood.² Total cholesterol and LDL-C concentrations are generally higher in girls and peak about 1 year earlier than in boys.²

Skin cancer is the most commonly diagnosed cancer in the United States. It is an abnormal growth of cells that begins in the outermost (epidermal) layer of the skin and is broadly classified as melanoma and nonmelanoma skin cancer. The incidence of melanoma, the most severe form of skin cancer, has been increasing, but overall melanoma mortality rates have not increased significantly.^1-3 Although 2% of all skin cancers are melanoma, it is estimated to cause more than 80% of skin cancer deaths.^4,5 UV radiation causes most skin cancers through damage to DNA⁶ and represents the major environmental risk factor for all types of skin cancer.^7,8 Five-year survival for melanoma is 98.4% for local-stage disease to 17.9% for distant-stage disease.^9,10 Thus, behavioral counseling promoting behaviors for reducing UV exposure, and skin self-examination to identify and report suspicious lesions, could prevent skin cancer.

Familial hypercholesterolemia (FH) is an autosomal dominant disorder of lipoprotein metabolism characterized by highly elevated total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) concentrations early in life. The estimated prevalence of heterozygous FH is 1 in 200 to 1 in 500 in North America and Europe and higher for populations with known founder effects.¹ Long-term exposure to elevated serum cholesterol is associated with atherosclerotic burden,^2- 5 and untreated FH has been associated with increased relative risk of coronary heart disease (CHD) events and CHD mortality.^6- 8 Quiz Ref ID The excess relative CHD mortality risk is highest between ages 20 and 39 years, a group with very low baseline CHD mortality, and decreases with age.^6,7

Unnecessary care contributes to high costs and places patients at risk of harm. While most providers support reducing low-value care, changing established practice patterns is difficult and requires active engagement in sustained behavioral, organizational, and cultural change. Here we describe an action-planning framework to engage providers in reducing overused services. The framework is informed by a comprehensive review of social science theory and literature, published reports of successful and unsuccessful efforts to reduce low-value care, and interviews with innovators of value-based care initiatives in twenty-three health care organizations across the United States. A multi-stakeholder advisory committee provided feedback on the framework and guidance on optimizing it for use in practice. The framework describes four conditions necessary for change: prioritize addressing low-value care; build a culture of trust, innovation and improvement; establish shared language and purpose; and commit resources to measurements. These conditions foster productive sense-making conversations between providers, between providers and patients, and among members of the health care team about the potential for harm from overuse and reflection on current frequency of use. Through these conversations providers, patients and team members think together as a group, learn how to coordinate individual behaviors, and jointly develop possibilities for coordinated action around specific areas of overuse. Organizational efforts to engage providers in value-based care focused on creating conditions for productive sense-making conversations that lead to change. Organizations can use this framework to enhance and strengthen provider engagement efforts to do less of what potentially harms and more of what truly helps patients.