The UCLA Department of Medicine lead a coalition of six partners working toward a dramatic reduction in low-value care. The coalition included:
- Los Angeles County Department of Health Services (LAC DHS)
- LA County Department of Public Health
- LAC DHS Primary Care Practice Based Research Network
- The Wellness Center at Historic General Hospital
- Society of General Internal Medicine
The partners focused on reducing:
- antibiotic prescriptions for upper respiratory infections;
- preoperative testing for routine cataract surgery; and
- imaging for low back pain.
They also promoted provider awareness of and support for the Choosing Wisely society recommendations and conducted a survey of patient willingness to engage in shared decision-making about low-value care.
Clinician interventions included embedding a clinical decision-support program into electronic health records, educating providers, coalition building, workflow improvements and offering links for physicians to the consumer-friendly materials produced by Consumer Reports.
Consumers were informed about the campaign through to educational videos and handouts (in Spanish and English) in reception areas and public service announcements on local television and radio, and via social media.
Stories of Success
Reducing Unnecessary Care to Under-Resourced Patients in Los Angeles
Los Angeles County Department of Health Services (DHS) is the second largest health system in the country and the largest “safety net” health system serving vulnerable populations. All told, 90 percent of patients who are seen by Los Angeles County DHS are at or below the federal poverty level.
This presents a unique challenge in communicating the Choosing Wisely lessons to patients: How do you tell a community that has traditionally had its health care needs neglected and/or has not had full access to health care in the past, that “less” care is actually better?
Working in close collaboration with representative community organizations, the UCLA/LA County DHS team created a survey to better understand patients’ awareness and attitudes and is designing a culturally sensitive patient education intervention that includes wellness alternatives to unnecessary medical care. This was implemented in combination with provider-level interventions based in behavioral economic principals to incentivize physicians to decrease ordering low-value tests and treatments.
“I was struck by how some of the most exciting interventions being done in the country to reduce unnecessary care are being done in higher-income communities and not necessarily with lower-income minorities,” said Catherine Sarkisian, MD, MSPH, Professor, Department of Geriatrics. “And at first there was suspicion from some of our community partners who advocate for lower income communities. But we’re starting to see this message of less is actually more take hold. It would be a real tragedy if under-resourced people are the last to benefit from the new science and continue to get low-value care long after other people have stopped receiving unnecessary care and all the associated problems.”
In Their Own Words