Addressing the Learning Curve
Hundreds of clinicians in the Lehigh Valley Physician Hospital Organization (LVPHO) have voluntarily completed TLC (The Learning Curve) modules to review evidence-based Choosing Wisely recommendations, learn why some tests and treatments might not be necessary, and improve patient care.
The video modules were developed by the Lehigh Valley Health Network’s Division of Education and introduced through LVPHO’s internal educational forum to more than 1100 physicians in early 2016.
An introductory video outlines the Choosing Wisely campaign; 10 subsequent videos are hosted by leaders of the medical staff. Each focuses on a specific Choosing Wisely recommendation from medical specialty societies, including the American College of Physicians, American College of Cardiology and American Academy of Family Physicians.
“We did a lot of exploratory work, including surveying clinicians, before we deployed the modules to make sure there was interest,” said Dr. Mark Wendling, Medical Director of LVPHO. “One theme that came out of the survey is that clinicians were familiar with evidence-based guidelines but were challenged with implementing them. For physicians, having a framework to begin to change was really important.”
While completion of the modules is not mandatory, physicians can earn AMA PRA Category Credit, meet Achieving Clinical Excellence® (ACE) measures and may qualify for continuing medical education (CME) credit.
As LVPHO continues to promote existing TLC modules and explore creating new ones, the organization is developing a dashboard to track and compare clinician ordering behaviors over time based on data from all practices in the network. Though the dashboard has not launched yet, LVPHO has already started looking at analytics related to imaging for acute low back pain and what drives the variation in care of that condition.
“The data gives us an idea of how we’re doing and what we might not be doing and what is driving that,” Dr. Wendling said. “We can see how clinicians vary in performance based on the episode and will be able to find the cause for ordering the test or treatment. It gives the power to the physicians who are trying to improve based on recommendations.”
Another phase of LVPHO’s work will be developing and disseminating patient-friendly Choosing Wisely videos through the Lehigh Valley Business Coalition on Healthcare. Consumer Reports produces a number of patient-friendly materials that are traditionally distributed to both patients and physicians so they can engage in informed conversations about the best course of care. The coalition is working to broaden this engagement by creating a Choosing Wisely video specifically for patients related to acute low back pain that will focus on questions they should ask their doctors when seeking care for that condition.
Though it is still too early to determine which interventions are working best, Dr. Wendling said LVPHO’s multiple efforts to improve the quality of care have already led to promising results.
“We did see a nearly 10 percent reduction in unnecessary MRI imaging,” he said. “I can’t cite Choosing Wisely as the reason for this, but efforts surrounding the campaign are woven into many other population-based health initiatives. The overall effect appears to be clear.”