Group Health Gives ‘A Good Nudge’
Group Health Cooperative, a Seattle-based nonprofit health care system that coordinates care and coverage, has a history of addressing waste and employing evidence-based medicine. Group Health has created thousands of decision aids and has worked on shared decision-making, focused on patient preferences related to surgical procedures.
“This type of work is part of our culture, so it makes it easier to introduce concepts like Choosing Wisely®,” said Matt Handley, MD, Medical Director for Quality for Group Health. “The campaign is an incredibly important part of efforts to improve quality and reduce waste.”
In June, the ABIM Foundation announced a new round of grants that allows Choosing Wisely grantee Washington Health Alliance (WHA) to continue to partner with provider organizations, including Group Health, to target the overuse of antibiotics for upper respiratory viral infections, imaging for uncomplicated headaches and overly frequent Pap tests for women between the ages of 30 and 65.
In 2013, Group Health worked to reduce too-frequent Pap tests after reviewing practices and discovered nearly 8,000 unnecessary Pap tests for women ages 21 to 65, based on Choosing Wisely recommendations.
To decrease unnecessary tests, Group Health tried using an electronic trigger tool. Dr. Handley said they gave clinicians data about doing Pap tests too frequently – and then followed up. Clinicians who ordered inappropriate tests received messages three days later with information about the evidence against overtesting, including the Choosing Wisely recommendation, as well as an invitation to have a conversation with a colleague.
To gauge how the alerts were working, Dr. Handley spoke with a handful of physicians and a few voiced the same sentiment: “It is a good nudge.”
“They said it was a reminder that kept the evidence at the forefront of their mind,” Dr. Handley said. “And it was helpful that it came so soon after ordering.”
In 2014, Group Health reported a 26 percent reduction of too-frequent Pap tests. Dr. Handley attributes similar success at Group Health to transparent utilization data, which can inspire open conversations about how care is delivered; Choosing Wisely, which resonates with specialists, since recommendations are directly from specialty societies; and Choosing Wisely materials from Consumer Reports, which have been helpful in engaging patients in conversations about low-value care.
“The brochures and handouts for patients are extremely direct and use plain language to explain what might not be appropriate care,” Dr. Handley said. “Most people are not interested in certain procedures if they have the full explanation.”
In addition to distributing Consumer Reports materials through the Choosing Wisely campaign, Group Health also embedded a Consumer Reports Choosing Wisely microsite into its patient portal, which 75 percent of its patients access. Group Health is also experimenting with using Consumer Reports handouts during triage in emergency care. As Group Health continues to work with WHA around the Choosing Wisely grant, Dr. Handley said there is interest in testing triggers and alerts for antibiotics prescribing.
