Choosing Wisely Changing How Maine Health Systems and Practices Deliver Care

ABIM Foundation grantee Maine Quality Counts (MQC), a regional collaborative that leads health improvement activities, is working to promote awareness of Choosing Wisely® recommendations across the state. To facilitate this spread, MQC partnered with four local systems.

PenBay Healthcare (PBH) serves 25,000 patients in the Rockport, Maine area. Leaders there are reviewing Choosing Wisely recommendations with physicians at departmental meetings, focusing on the emergency department and adult and pediatric primary care. PBH is also requiring that in-patient, pre-operative and emergency department order sets be reviewed and tailored to discourage routine ordering of low-yield procedures, such as CT scanning for uncomplicated headaches and imaging for low back pain. Some preliminary efforts are underway to track utilization of some of those procedures, and the results are then shared with physicians. PBH is also partnering with the Picker Patient Resource Center, which is part of the PBH system, to disseminate consumer-friendly Choosing Wisely materials to patients.

David Bachman, MD, PBH’s chief medical officer, said its physicians had embraced the campaign because the recommendations are coming from fellow physicians instead of an outside force “coming in with rules and regulations.” Dr. Bachman called Choosing Wisely “a breath of fresh air” that provides “common sense reminders” that “less can be more.”

“It’s hard to argue with this stuff,” he said. “This provides a nudge of support for not providing unnecessary care, and provides more evidence than physicians might have known existed.” He also noted that patients “almost universally understand” when their physicians explain why a particular test or procedure is unnecessary.

Penobscot Community Health Center (PCHC) in Bangor is incorporating Choosing Wisely into its nurse practitioner residency training. There, residents use case-specific Choosing Wisely resources, and assess each other’s use of the materials in an effort to create best practices. PCHC has plans to place consumer posters about Choosing Wisely in waiting areas and exam rooms, and educate medical assistants and health coaches about the campaign. PCHC will also report statistics on utilization of imaging to clinicians, and how their utilization compares with their peers.

Winthrop Family Medicine, which serves 6,700 patients, has added Choosing Wisely educational presentations as a standing agenda topic for all provider meetings, added links to the Choosing Wisely website on all exam room computers and provider laptops, and provided easy access for all staff and patients to printed materials describing campaign recommendations. Dr. John Barnes, Winthrop’s medical director, said the practice is still experimenting with how best to communicate with patients about Choosing Wisely—it has tried giving handouts to patients when they sign in for their visits and put posters about the campaign in exam rooms. He thought that Winthrop’s next step would be for clinicians to urge patients to ask them questions about whether particular tests and treatments are necessary.

Oxford Hills Family Practice (OHFP) is the smallest of the four systems, serving about 2,700 patients in the Norway area, and is located in a county with among the poorest health outcomes in the state. In collaboration with a local community health coalition, OHFP has launched twin efforts. On the provider side, physician leader Rebecca Chagrasulis, MD, has met with the entire practice group – including providers, medical assistants and office personnel – to discuss the Choosing Wisely recommendations about imaging for low back pain and antibiotics for sinusitis, the first two focus areas for OHFP. Dr. Chagrasulis is reviewing compliance with the guidelines and providing feedback to the practitioners. The practice group is meeting monthly to discuss Choosing Wisely and will focus on additional recommendations in the coming months.

For consumers, Choosing Wisely materials are posted on a bulletin board in the practice waiting room and a campaign-produced video discussing how to ask your provider questions plays on the waiting room television. Exam rooms are equipped with hard copies of Choosing Wisely handouts to make it easier for clinicians to share them with their patients.

“Now that all in the practice are familiar with the Choosing Wisely campaign, they are working together as a team to implement evidence-based guidelines, and use the material for shared decision-making with their patients,” Dr. Chagrasulis said.