Exploring the Effects of Putting It Out There
The Medical College of Wisconsin (MCW) is launching a study that will provide more insight into breast cancer care across the state.
The study is backed by a four-year grant MCW received in 2014 from the National Institutes of Health (NIH). The NIH grant program is part of the National Cancer Institute’s Provocative Questions initiative, an effort seeking new approaches to reduce use of ineffective and unproven cancer treatments.
MCW’s research team identified 10 commonly prescribed breast cancer tests and procedures that may be unnecessary. Eight are included on Choosing Wisely® lists from the American Society of Clinical Oncology, American College of Surgeons, American Society for Radiation Oncology and Commission on Cancer. The other two draw from National Comprehensive Cancer Network (NCCN) guidelines.
The study is being carried out in partnership with the Wisconsin Collaborative for Healthcare Quality (WCHQ), a grantee of the ABIM Foundation working to advance Choosing Wisely. As a statewide consortium of 40 organizations focusing on quality reporting, WCHQ provides an ideal laboratory in which to test the proposed interventions.
“WCHQ is already providing quality metrics for certain conditions or procedures, such as colonoscopy and mammogram rates for patients in our state,” said Ann Nattinger, MD, of MCW. “That was an advantage for us. It’s an uncommon resource we have. We didn’t have to start from scratch.”
Most of the WCHQ health systems across the state have agreed to participate in the study, which kicks off in November 2015. Investigators will measure how frequently the 10 procedures are prescribed for breast cancer patients among participating practices and will report those metrics through WCHQ’s website. There will be five snapshots of utilization rates during the 30-month study period.
MCW will launch the second phase of the project in fall 2016. In addition to the creation of an app – designed to provide just-in-time information, patient education materials and decision tools to providers – investigators will host educational presentations on the app and will encourage participating practices to promote the app via email reminders and updates.
At the conclusion of the second phase, MCW will study WCHQ data to determine if using the app coupled with public reporting had a greater impact than the public reporting alone—and if so by how much.
Researchers hypothesized that, over time, public reporting and the subsequent introduction of the app will lead to a change in practice patterns and the reduction in the utilization of such metrics.
“We are very hopeful, as things are proceeding well during the early stages of the work,” said Liliana E. Pezzin, PhD, of MCW’s research team. “We have had some early successes.”