Implementing Choosing Wisely in Rural Communities
Jill Daughhetee, Quality Improvement Advisor for the Kansas Healthcare Collaborative, which is part of the Compass Practice Transformation Network, introduced 26 practices and health systems to Choosing Wisely last summer.
Her first step in engaging clinicians across the region, many in small or solo practices, was to provide posters about the “5 Questions to Ask Your Doctor Before You Get Any Test, Treatment or Procedure” to display in patient exam rooms. While some clinicians may think they answer all patients questions at each visit, many patients may hesitate to ask certain questions or think of questions after their visit. The posters, Daughhetee said, create a culture for questions and conversations at the right moment.
“Choosing Wisely is the path of least resistance,” she said. “It is the easiest shared decision-making tool to train staff about appropriate care. It’s really applicable in any practice.”
Advantages and challenges in a rural setting
Creating an intervention in small, rural practices has its advantages. They are usually tight-knit communities where people know each other. It can also be easier to get buy-in from a small team whose members are used to being nimble and creative, and working with limited resources at times.
Some of the challenges in a rural setting, however, can be that staff play multiple roles at once, i.e., working as both manager and as quality officer, and it can be difficult to gather metrics if, for instance, multiple imaging centers service one facility.
One rural practice’s success with Choosing Wisely
While nearly all of the practices to which Daughhetee reached out started to use the posters and train staff about Choosing Wisely, some took the initiative further, including a small team at Kiowa District Healthcare.
Kiowa is an eight-bed Critical Access Hospital and Rural Health Clinic in a community of about 1,000 people. The team there used the exam room posters, but didn’t know if patients were engaging with the information, particularly when clinicians forgot to draw their attention to it.
Melissa Stroh, a Physician Assistant at Kiowa, said the practice was already giving every patient a “check-out list” after visits. The list included their vitals, follow-up information and personal reminders about next steps. They decided to include Choosing Wisely information on the reverse side of these handouts.
“The patients don’t leave empty-handed,” she said. “Every single patient gets the handout every single time. It’s something they can hang on their refrigerator and refer back to. It really encourages patients to ask questions.”
The handouts also serve as reminders for Kiowa staff to bring up Choosing Wisely, helping them figure out the best ways to talk about the campaign in their setting. The return on investment of giving patients important reference material about their health was determined to be worth the minimal cost to print the materials, Stroh said.
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