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As noted in a previous blog post, Choosing Wisely is gaining traction abroad. Global initiatives include Choosing Wisely Canada, Choosing Wisely Netherlands and “Slow Medicine” in Italy. I am fascinated by the different ways other countries are promoting the campaign to physicians and patients, and leveraging it to tackle issues prevalent in their particular health systems.
I recently spoke to several health system/hospital quality experts and physician groups in Upstate New York about the Choosing Wisely campaign. I was looking forward to speaking about the campaign to a hometown crowd (I was born and raised in Syracuse) and an audience that included my former next-door neighbor, the regional president of Excellus. The campaign has been so well-received by audiences all over the country, I was expecting a particularly warm reception at home. How wrong I was!
A number of specialty organizations have identified preoperative testing (i.e., lab tests, x-rays and cardiac testing) in healthy patients undergoing low-risk surgery as a frequently overused service and have included it on their Choosing Wisely® lists of tests and procedures that may be unnecessary. As preoperative testing may be ordered or requested by a multiple groups of physicians—surgeons, anesthesiologists, general internists or pediatricians or medical specialists—ensuring its appropriateness is complex. On April 30, the New York Academy of Medicine (NYAM) and the ABIM Foundation sponsored a multispecialty panel discussion to define appropriate preoperative testing and to discuss:
- potential harms of overtesting;
- reasons why overtesting is common; and,
- strategies to optimize testing.
Since the ABIM Foundation created the Professionalism Article Prize in 2011, I have been amazed by the thoughtfulness that goes into selecting the winners. After a review of a year’s worth of literature by Foundation staff, a select committee narrows down more than a hundred articles on various aspects of professionalism to the three they deem most important. For this, the committee deserves a special thank you.
It’s incredible to see Choosing Wisely spread throughout delivery systems, local communities and internationally. To see it grow in residency programs gives me particular joy knowing that the next generation of physicians will have competencies in stewardship and systems-based practice that surpass the current physician workforce.
Last week, 21 sub-grantees of the Robert Wood Johnson Foundation assembled at the Choosing Wisely Summit to learn from each other, advance skills to spread the awareness of the campaign and plan for the future. The event was a great success; I felt that all of the grantees were re-energized after sharing their stories and learning about the work of their peers. One of the simplest yet most profound takeaways from the meeting—for me, at least—was the reminder of the old adage, “if at first you don’t succeed, try again.”
On April 30, 21 diverse organizations will convene to present their findings and learn from each other about ways to advance the Choosing Wisely campaign at the local level. The ten regional health collaboratives and eleven specialty societies and state medical associations are sub-grantees of the Robert Wood Johnson Foundation (RWJF) and dedicated to improving the quality, patient experience and affordability of health care. They also share the commitment to use the framing of the Choosing Wisely campaign around waste and doing no harm to advance conversations between patients and physicians. They are connectors of organizations, patients, physicians and conversations around the Choosing Wisely campaign. They link the voice of the patient with the voice of the physician, setting this campaign apart from previous efforts: patient-physician partnership and physician leadership.
This type of analysis is a critical part of the transparent, honest dialogue about the issues of unnecessary medical care that we have sought to encourage since launching the campaign. That said, we think it is unfortunately shortsighted to measure the success of Choosing Wisely based on whether or not the physicians involved have cut their own income. Read more »
There is an interesting conversation taking place around Choosing Wisely® and a recent JAMA study by Pearson and Gliwa. It’s heartening to see that the campaign is doing what it was always meant to do – spark conversation.
In their study, Gliwa and Pearson sought to “evaluate the role that evidence on benefits, risks, and costs plays in selecting a service for the Top 5 lists.” They conclude “Specialty societies can enhance trust in the Choosing Wisely campaign by defining more clearly the types of potentially wasteful medical care they seek to eliminate, and by providing a clear evidentiary justification for the selection of each service.”
Tackling the concept of “waste” in health care is not an easy thing. There are many factors that contribute to waste – higher costs and unnecessary treatments being only a couple of them. In the end, the Choosing Wisely campaign originated out of the desire to provide a space for waste to be discussed—between physicians and their patients, groups of physicians and physicians and the organizations in which they work.
On March 27, HealthInsight Utah hosted a town hall on the campus of the University of Utah. HealthInsight Utah is a sub-grantee of a Robert Wood Johnson Foundation grant to the ABIM Foundation to increase awareness of the Choosing Wisely campaign at the local level. They are one of 21 grantees who are all pursuing tactics to initiate conversations about overuse.