Founded in 2003, the Wisconsin Collaborative for Healthcare Quality (WCHQ) is a voluntary, nonprofit consortium of 38 organizations—including health systems, medical groups and hospitals—committed to using the public reporting of comparative measures of performance to catalyze improvements in the quality and affordability of health care in the state, in turn enhancing the health status of individuals and communities.
The Wisconsin Collaborative for Healthcare Quality (WCHQ) recognized the Choosing Wisely campaign as a unique opportunity to educate and engage physicians and patients in meaningful conversations and actions around appropriate care at the appropriate time.
Guided by a multi-stakeholder advisory committee, WCHQ selected 10 of the Choosing Wisely specialty society recommendations to focus on in Wisconsin, while also designing and hosting a Choosing Wisely kickoff meeting attended by 150 people during its initial outreach efforts. Selected recommendations focus on:
- Reducing antibiotic prescriptions for acute bronchitis;
- Reducing diagnostic imaging for low-back pain; and
- Reducing blood transfusions for inpatients.
Froedtert & the Medical College of Wisconsin have been working to reduce the use of unnecessary tests and procedures since before the start of the Choosing Wisely grant. As a result, its efforts are in various stages of development. For instance, the team heading the work to reduce the use of diagnostic imaging for low-back pain began academic detailing six months prior to the start of the grant. They are currently working to optimize their decision support and workflows in the EHR system, as well as providing performance data to clinicians and leadership. The team working on the reduction of antibiotics prescriptions started at square one at the onset of the grant and is now moving beyond the pilot phase with academic detailing, workflow enhancements and transparency of data.
Monroe Clinic is sharing evidence and education with clinical providers, providing monthly, unblinded individual provider and group reports of inappropriate antibiotic use within the organization and incorporating patient education and engagement using Choosing Wisely tools. Monroe Clinic has initiated focus on consumers via direct mailing, a radio campaign featuring one of their primary care providers, and a Web page.
WCHQ also works with its membership to advance the Choosing Wisely campaign through one-on-one meetings, presentations at Grand Rounds and working with patient advisory councils. It has shared Choosing Wisely materials broadly across Wisconsin to reach physicians and patients via email, web resources and social media outlets.
Working with its members and health care industry vendors, WCHQ is developing decision support tools within EHR systems to improve access to the Choosing Wisely recommendations and other technology-based tools that will assist physicians in recognizing and acting upon appropriate Choosing Wisely recommendations.
Stories of Success
Gradual Change and Learning in Wisconsin
“Our work is unique in the fact that each of our groups are at different stages of the process,” says Charlene Remy, Clinical Quality Coordinator, Froedtert & the Medical College of Wisconsin (F&MCW). “Because our three groups are at different stages of development and implementation, we can easily learn from each other and adapt our learnings toward the best path going forward. This has proved to be incredibly helpful so far.”
The shared learnings are paying off in clinical results. At the close of the first year of the grant, F&MCW has seen significant clinical improvement, including reductions of more than 20% in blood utilization. This was followed by a reduction in imaging for low back pain of more than 10%, while inappropriate antibiotic prescribing has had minimal improvements to date as implementing interventions is just getting underway. The staff at F&MCW has focused their sites on maintaining the reductions, continuing innovations and spreading the results. For example, with the success of their inpatient blood utilization, the group is considering how the lessons can be used and implemented to better steward other blood products.