With nearly 800 employed physicians working across eight regions throughout Utah – along with a large complement of non-employed physicians – Intermountain Healthcare’s policies and practices shape care delivery throughout the state. Intermountain is commonly considered among the nation’s highest quality and most efficient health care systems, but its leaders recognize that it is far from immune when it comes to providing unnecessary care. Thus, it is using Choosing Wisely® to strengthen its efforts to reduce waste and provide the right care at the right time.
One major step Intermountain has taken has been to develop a report that gives clinicians detailed information – including a graphical display – about their utilization of a number of interventions questioned in Choosing Wisely recommendations and how that utilization compares to their peers at their site, their region and the system as a whole. The interventions are:
- MRI and CT imaging in low back pain cases;
- antibiotics at sick visits;
- lab ordering at preventive visits; and,
- HPV and Pap smear testing.
After visiting all of the system’s physician groups in 2013 to talk about Choosing Wisely and this new reporting system, Intermountain leaders are planning to do another round of visits this year. They will bring with them the latest individual physician data.
“We don’t say that these results show that you’re good or bad,” said Wayne Cannon, MD, Intermountain’s primary care clinical program leader. Rather, he stressed that the information is designed to help physicians understand their usage patterns, how and why they may differ from their peers, and whether physicians should consider any adjustments to their practice patterns. He also described many barriers to reducing unnecessary care including tradition, peer pressure, defensive medicine, patient expectations and the refusal of specialists to provide consultations without imaging results.
In addition to providing individualized clinician data, Dr. Cannon and colleagues will also bring with them detailed “Best Practice Flash Cards” that Intermountain developed to help guide clinicians in diagnosing and treating a number of conditions, including low back pain and sinusitis in adults, and otitis media in children. These flash cards are complemented by handouts for patients that are developed by the system’s educational unit. Intermountain has provided patients with handouts describing low back pain treatments and prognoses for nearly a decade.
Intermountain is also working to incorporate Choosing Wisely recommendations into its electronic medical records system, a process that it anticipates will be complete by October 2014.