Patient Engagement in Low Value Care – Inform

This technical assistance package aims to provide insights and tools to implement patient engagement around overuse in your organization. Use all four components or focus on one element. Each section is broken into  sections by time commitment:

• If you have five minutes, check out our top five insights from each area.

• If you have twenty minutes, read sample scripts, review tools or listen to a short podcast.
• If you have an hour to dedicate, read the source journal articles, watch a webinar or join our learning network to connect with others.

If you have 5 minutes …

Five Things to Consider when communicating with patients to reduce low-value care:

Build overuse conversations into practice workflows and use a team approach: Consider building processes into your practice workflows to set expectations about tests and treatments that are too frequently used and involve your care team, so patients hear the Choosing Wisely message in multiple ways from multiple people.

Address both low-value and high-value care opportunities:  Some patient populations understandably have concerns that decreasing even low-value care could be a risk for withholding needed care; to build trust, remember to encourage evidence-based, high-value care (e.g. USPSTF preventive care) while also stressing the importance of reducing low-value care.

Use your communications team:  Incorporate the 5 Questions and messages about overuse into general communications to patients. Reinforce your message with posters, decision aids and additional patient-centered materials.

Don’t be afraid to ask:  Financial costs of health care tests and treatments, particularly low-value care, can have significant impacts on patient care and outcomes. Studies have shown that many patients are reluctant to mention their difficulty paying for health care, but appreciate it when their provider asks about their concerns. Patients are acutely aware of both the direct and indirect costs of medical tests and treatments, including lost income from time missed from work, transportation, and child care.

Find opportunities to help patients understand what information sources are trustworthy and how they can find information to help make health decisions: Patient focus groups tell us that many patients trust their own research most but often find information with a wide range of evidential support. Providing disease or condition information from trusted sources and helping patients better understand how to evaluate evidence should improve your communication.

If you have 20 minutes…

Read

• Understand potential patient harms with this Map of Harms
• US Internists’ Perspectives on Discussing Cost of Care with Patients 
  This article shares experiences and strategies about having cost conversations.
• Examples of Communication Strategies Clinicians Can Use to Present Complicated Information to Patients
  This table provides examples from cancer care on clinician communication.

• Important Functions of Patient-Clinician Communication
  This information sheet focuses on communicating about safety at transitions of care in a hospital.

• How do Patients Make Health Care Decisions?
  Results from a patient survey at Sharp Rees-Stealy about health care decision making.

• Choosing Wisely and State Innovation Models Align in Maine
  This newsletter article shares insights from practices regularizing conversations about overuse.

• Check out this Case Study: Access and Overuse in Rural Settings
  This case study shows a simple communication technique a rural health clinic used to encourage questions about overuse.

• Understanding Cost of Care Conversations
  ACP provides a quick resource guide for physicians interested in starting cost conversations.

Watch

•  Physician Communication Modules: Drexel University College of Medicine developed this set of interactive instructional modules to enhance physician-patient communication when implementing Choosing Wisely specialty society recommendations.

Do

• Consider using the Choosing Wisely “Five Questions to Ask Your Doctor Before You Get Any Test, Treatment, or Procedure” with patients in your practice

• Identify and use condition-specific Choosing Wisely patient materials in your practice for targeted low-value tests and treatments

If you have sixty minutes…

Read

• Communicating About Overuse with Vulnerable Populations

Watch

• Talking with Caregivers About Overuse – Webinar that discusses the different dynamics of discussing overuse with a caregiver

• Costs of Care Value Conversations Series: this set of 4 modules illustrates key issues related to having value conversations with patients and staff

• Communication About Overuse with Vulnerable Populations – This webinar shares insights from focus groups with low income patients and key informant interviews with safety net providers.

Do

• Use this “Using Choosing Wisely Tools to Empower Patients” to identify specific ways to engage patients in Choosing Wisely in your practice

• Listen to “Conversations on Medical Overuse,” a set of 3 podcasts developed by Health Partners that provide examples of a simple clinician-patient conversation, a complicated conversation, and a polarized conversation, that illustrate optimal approaches to conversations on overuse.

• RIGHT QUESTION, WRONG PERSON:A Toolkit to Facilitate Cost-of-Care Based on a survey of health systems using the five questions, this toolkit crowd sources tactics and resources to implement cost conversations at a systems level.