Costs of Care and the ABIM Foundation received 80 submissions from across the United States and Canada from medical students, residents and faculty as part of the second annual Teaching Value and Choosing Wisely® Challenge.
On March 5, six winners were named in two categories. Winners included McGill University in the “Innovations” category for projects that are either completed or underway, and the University of Chicago in the “Bright Ideas” category for proposed interventions that could be successfully implemented on a larger scale.
“It’s quite a competition, and a lot of people with great ideas entered,” said Dr. Todd Lee from the Department of Medicine at McGill University Health Centre in Montreal. “To be selected from among the submissions was very humbling and very much appreciated.”
Inspired by a CDC initiative to reduce antibiotic overuse, Dr. Lee and his colleagues, Drs. Charles Frenette, Dev Jayaraman, Laurence Green and Louise Pilote, created a program using trainee-led antibiotic “time-outs” to re-evaluate if the antibiotics their patients were receiving were still appropriate. Residents were encouraged to take two time-outs per week to consider what they learned during monthly education sessions and from a structured electronic tool kit—before making a decision to continue, change or stop a patient’s antibiotic prescription.
To determine if the time-outs were reducing inappropriate antibiotic prescribing, McGill studied pre- and post-intervention data focusing on four key groups of antibiotics. These data were analyzed in terms of overall number of doses per patient-day and in terms of costs. After a year, costs were reduced by 46 percent and there was a decrease in drug use in two of four classes targeted.
The decrease in inappropriate antibiotic use inspired McGill to expand time-outs to other areas, including Foley and central venous catheter use, laboratory tests and other Choosing Wisely® recommendations.
“Physicians are very busy, and care is complicated,” Dr. Lee said. “If you don’t have a simple, regimented process, stewardship can fall by the wayside. We need to be prompted to stop and think about it.”
Another Teaching Value and Choosing Wisely® Challenge entrant was recognized as a “Bright Idea” winner for prompting medical trainees to think about dilemmas patients face. A team from the University of Chicago, including Drs. Jonas de Souza, Jeremy O’Connor, Chadi Nabhan and Christopher Daugherty, and Aamir Hussain, MS, and Bonnie Yap, MS, saw financial advisors and social workers talking about costs of treatment with cancer patients, and proposed bringing medical students into those meetings so they could better understand the financial burdens many patients face in addition to their medical care.
“We characterized the cost of cancer care as a side effect of what we do,” said Dr. de Souza. “We wanted medical students to understand that treatment has consequences beyond survival or physical side effects.”
Dr. de Souza said that winning the Challenge helped the project, which is in the planning stages, gain momentum.
Through a new learning network, winners and entrants can continue conversations, share ideas and connect with others in the health care community about how to make stewardship of resources part of medical training. The learning network is open to all medical residents, students, faculty and others who are committed to advancing stewardship competencies and high value care. It also features a monthly “Third Thursday” webinar series, which continues April 16 at 12 pm ET. Daisy Smith, MD, FACP, senior physician educator at the American College of Physicians (ACP), will discuss ACP’s High Value Care Curriculum.
Dr. Lee said the network creates a space for people who have expertise in quality improvement to provide feedback and offer suggestions, which could steer a project in a new direction or inspire others to take on the challenge.
“When you do this kind of work, your major goal is to make a local difference in education and patient care,” he said. “It’s an even bigger bonus if other people can learn from it.”