Few systems are as associated with avoiding overuse as Kaiser Permanente. Nonetheless, its Colorado branch has embraced Choosing Wisely and is using the campaign’s recommendations to improve how it delivers care.
“Choosing Wisely is the most welcome thing we’ve ever seen,” states Margaret Ferguson, MD. In her role as associate medical director for affordability at Kaiser Permanente Colorado, Dr. Ferguson is responsible for achieving the Triple Aim (improving patient experience of care, improving the health of the population and reducing the cost of care) in her region.
The Kaiser Permanente Colorado effort began by asking all department heads to review the Choosing Wisely recommendations related to their specialty with their physicians and ensure that their practice patterns were consistent. At the institutional level, they reviewed all of the Choosing Wisely recommendations and chose to focus on 20, primarily in the imaging area.
Based on this institutional review, Kaiser Permanente has launched projects to reduce imaging overuse for/of:
- Uncomplicated headaches
- Carotids for syncope without neurologic symptoms
- Low back pain
- Adnexal cysts
- Pulmonary embolism with low probability
In performing chart reviews to determine whether overuse in these areas is widespread, Kaiser Permanente estimated up to 25 percent of its employed physicians’ orders of imaging for uncomplicated headaches may have been unnecessary.
The primary intervention in these projects is to reach out to physicians who are outliers in ordering these imaging tests. Dr. Ferguson said that Choosing Wisely gave Kaiser Permanente Colorado the opportunity to learn how to get physicians to stop doing things that offer no value. “This gives us a whole new way of presenting affordability,” Ferguson said. “We can measure the value of doing something based on evidence.”
Kaiser Permanente Colorado has four additional imaging projects in the pipeline, along with an effort to reduce the use of routine physical examinations for asymptomatic adults and a focus on unnecessary genetic testing.
Kaiser Permanente Colorado’s outreach efforts aren’t limited to its physicians. The system is also employing the consumer “translations” of the recommendations produced by Consumer Reports. According to Ferguson, “everyone walks around with their hard copies” of the translations to share with patients.