Virginia Mason Medical Center is a subsidiary of Virginia Mason Health System. It includes Virginia Mason Hospital in Seattle, Bailey-Boushay House in Seattle and a regional network of outpatient medical facilities in Bainbridge Island, Bellevue, Edmonds, Federal Way, Issaquah, Kirkland, Lynnwood and Seattle (downtown and University Village).1
Upon recognition of underperformance on the Washington Health Alliance (WHA) Community Checkup Report measure for acute bronchitis antibiotic prescriptions, Virginia Mason clinical leaders implemented a Choosing Wisely® initiative to reduce antibiotic overuse.2,3
The antibiotic overuse reduction initiative was piloted through academic detailing of all institutional primary care providers in Virginia Mason’s network, tracking and benchmarking antibiotic prescription rates for acute respiratory infections through a data report. Employing external guidelines and the Choosing Wisely campaign as the benchmarks for best practice, chart review data was utilized to engage in conversations with individual physicians and practices, emphasizing the importance of antibiotic reduction. Virginia Mason gave clinicians unblinded data comparing their performance with their peers, enabling them to learn from positive deviants. Data was also presented to physician leaders at all nine of Virginia Mason’s medical centers. Virginia Mason established an acute respiratory illness (ARI) care pathway to offer nurse phone care instead of office visits for patients calling to schedule visits for ARI-related symptoms. It later developed a documentation template to guide providers to choose evidence-based care for patients presenting to the clinic for ARIs.2,3
The intervention occurred among 54,283 acute upper respiratory infection episodes. Post intervention, nurse phone consultation involved 13.8% of care episodes. Results included: “16.5% absolute decrease in antibiotic rate after adjustment, 8.3% episodes not requiring any provider visit post intervention and single institution cost savings to payers exceeding $175,000.”3 Virginia Mason went from 80% prescribing for acute bronchitis in the Washington State Health Alliance Report Card to one of the lowest among medical groups originally included in the denominator.2-4
Virginia Mason has reported continuously low rates of potentially inappropriate antibiotic prescribing when tracking internal data, even with adding new providers throughout the department and implementing walk-in/urgent care at a few of our regional medical centers. The specifications created as part of this work have formed the foundation for the Washington Health Alliance Choosing Wisely statewide specification.3
The original case study can be viewed here.