While looking into Anne Arundel Medical Center’s role as a regional health system, staff and administration had been thinking about using the Choosing Wisely® campaign to improve the health of the community.
“We understood the need to focus more on wellness and recognize ourselves as part of a public health enterprise, and not just a treatment facility,” said Barry Meisenberg, MD, Director, DeCesaris Cancer Institute, and Chair, Health System Quality and Research, at Anne Arundel. “Choosing Wisely fit right into that. We challenged ourselves to embrace the issue of overutilization in order to change the culture for physicians and the public.”
A team of physician leaders and marketing staff at Anne Arundel developed messages and improvement initiatives for physicians and the public, hoping to inspire both groups to come together to have important conversations about what care is appropriate. The messages were chosen from Choosing Wisely lists for highest local impact and interest and were intentionally kept general.
Key messages for medical staff include “more is not always better,” “consider harms” and “follow professional society recommendations.” These concepts are reinforced during grand rounds, care conferences and continuing medical education. Choosing Wisely was also discussed at meetings of the Anne Arundel Cancer Council, which includes health care workers and public representatives.
Choosing Wisely lists were circulated to primary care practitioners (PCPs) and direct links to the lists requested by PCPs in the Accountable Care Organization were embedded into the electronic medical records (EMRs). Dr. Meisenberg noted that lists were not incorporated into the clinical decision support because they learned it was more effective to present the information before the ordering stage – not after.
Messages for the public included “more is not always better,” “there could be a risk of harm” and “have a dialogue, not a test.” Large screens placed in hospital lobbies, waiting rooms and physician offices displayed rotating messages promoting Choosing Wisely and encouraged people to visit the website for more information.
To expand the reach beyond the physical walls of its affiliated hospitals and physician offices, Anne Arundel used its magazine and press relationships to place articles and columns about Choosing Wisely in local, regional and national media. Anne Arundel also created a Choosing Wisely public service announcement for local radio stations and invited the public to lectures or other venues at the hospital to discuss Choosing Wisely and overutilization.
Dr. Meisenberg said changing behavior can be hard, but communication efforts have helped Anne Arundel reach hundreds of physicians and members of the public. Some clinicians have incorporated the campaign into daily conversations. For example, “That’s not very Choosing Wisely” has become a common phrase heard around the medical center.
While people are getting the message, Dr. Meisenberg said there are additional educational opportunities as well as plans to measure both awareness and impact.
“We are doing research on physician attitudes about low-value testing,” he said. “Preliminary data suggests physicians associate test ordering with being thorough, a culture developed early in their education and training, and they are also motivated by a desire not to be blamed if something is missed and concern for patient satisfaction. Optimizing the Choosing Wisely campaign will entail understanding and addressing these motivations. For the same reasons, we need to better understand patient motivation in seeking tests and therapies as well.”