When asked about the keys to their success integrating the Choosing Wisely campaign into physician offices and various workplaces across Rhode Island, Al Charbonneau and Joanne Bilotta concurred in their replies: “Boots on the ground.”
“The success to this has really been the face-to-face grassroots approach and the receipt of two generous grants from the Rhode Island Foundation which funded the resources and materials,” said Charbonneau, head of the Rhode Island Business Group on Health (RIBGH), which since 2016 has spearheaded educational and outreach efforts to put Choosing Wisely materials into the hands of clinicians, patients, and employers.
The campaign was endorsed by the Governor of Rhode Island and the General Assembly and rolled out to the State employees.
“We had quarterly summits and brought in speakers, but no one really committed to adopting the campaign until we sat face to face with doctors and benefits people to show them how they could get the information to their patients and workers,” he said.
That approach involved lots of meetings with scores of organizations, said Bilotta, RIBGH’s Choosing Wisely campaign manager. They also used Facebook ads and other social media to extend their reach and treated their efforts like a seat-belt safety or anti-smoking campaign by using public service announcements on local television.
“Getting out into the medical community and with employers was critical,” said Bilotta, adding that she provided orientation training to clinicians, practice managers, and employee benefits staff alike. “I would help them navigate the [campaign] website and find information,” including creating avatars for doctors to practice patient conversation based on physician communication modules on the website.
RIBGH kicks off 2020 with more than 60 employers having formally adopted the campaign by signing participation agreements to introduce Choosing Wisely to their employees. The employers have agreed to build educational outreach into their budgets to ensure the campaign is sustainable, and to incorporate it into wellness calendars and health fairs to encourage dialogue.
After working heavily with physician groups, all the major practices in the state representing over 70% of the practices in Rhode Island – including accountable care organizations and patient-centered medical homes – have embraced the campaign as well. RIBGH contracted with Patient Point, an organization that places video monitors in physician offices at no charge to the physicians so that more than 100 physician offices now show videos about “5 Questions to Ask Your Doctors.” The physicians also display the “5 Questions” posters regarding antibiotic overuse and distribute other Choosing Wisely patient materials.
This year, more than 400 physician practices have agreed to pick three recommendations to implement and to track their impact. Initial results will be available by the end of 2020. Some recommendations have been aligned with ICD-9 codes, a classification system for health issues and diseases, said Bilotta, and some physicians are beginning to use the codes in their decision-making to avert low-value care.
In addition, RIBGH has partnered with the State Department of Health and the Rhode Island Medical Society to combat oversubscribing of opioids; through database monitoring, the state can identify patterns of overuse and then share with practitioners Choosing Wisely information about opioid use.
Albert Puerini, MD, President and CEO of RI Primary Care Physicians Corporation (RIPCPC), said that the Choosing Wisely campaign has helped propel the mission of his 150-member primary care physician group.
“It’s reinforcement in an organized way of our efforts [to reduce low-value care],” said Puerini, adding that both physicians and patients make use of the website for reference, and patient materials are readily available in physician offices. RIPCPC serves about 150,000 patients statewide.
Also, each month Choosing Wisely is a topic of discussion at the group practice’s pod meetings, small gatherings of practice members at which they review quality measures such as ordering data on antibiotics, X-rays, and MRIs, for instance. The data is un-blinded so clinicians can see how they compare with their peers.
Choosing Wisely has also been integrated into the Care Transformation Collaborative of Rhode Island, one of the most successful patient-centered home initiatives in the nation and has become “part of a comprehensive approach to improving patient care and reducing costs,” said the program’s chief clinical strategist Pano Yeracaris, MD, MPH.
“There strong support and it’s growing,” said Yeracaris, adding that his group would be seeking additional ways to implement recommendations statewide that can reduce unnecessary care.