Choosing Wisely continued to expand in 2016 with new initiatives and lists and the ongoing work of many partners and grantees helping advance conversations about reducing overuse in health care. Let’s take a moment to look back:
The Choosing Wisely Champions program launched in March 2016 to recognize clinicians who are leading efforts to reduce overuse and waste in medicine. Champions are selected by participating societies and include clinicians or teams of clinicians whose work in their respective specialties advances the goals of the campaign. Ten societies have announced more than 40 champions, whose work includes, for example, more than a thousand drug adjustments for patients, decreased inpatient blood product usage by 46 percent over three years, and inspiring state legislation requiring that all children undergo vision screening prior to starting kindergarten.
Collaborations to Improve Outcomes
Choosing Wisely grantees are a little more than halfway through their projects to reduce the overuse of at least three tests or treatments – including inappropriate prescribing of antibiotics to adults – in their respective communities. Many are identifying new ways to collaborate to reach new populations and overcome barriers that have traditionally inhibited efforts to make and sustain measurable progress in reducing unnecessary care.
For example, the United Auto Workers Retiree Medical Benefits Trust is educating its 720,000 members in Michigan and beyond about Choosing Wisely. To address the opioid epidemic affecting Bangor, Maine Quality Counts provided Choosing Wisely opioid resources created by Consumer Reports to the community. The Los Angeles County Department of Health Services (DHS), the nation’s largest “safety net” health system serving vulnerable populations, is working with UCLA/LA County to create a survey to better understand patients’ awareness and attitudes and is designing culturally sensitive patient education materials.
Sharing Wallet Cards with #ChoosingWisely Wednesday
Every Wednesday, Consumer Reports posts pictures on social media of health care consumers, patients and stakeholders holding up the “5 Questions Wallet Card” that aims to help patients know the right questions to ask their clinicians. The goal of this effort is to educate clinicians and patients about Choosing Wisely and encourage them to engage in conversations about what care is necessary. To date, Consumer Reports has sent out approximately 80,000 of the free wallet cards and has received requests for thousands more. Consumer Reports says many have shared their wallet cards with family and friends as well as through medical settings, public libraries, senior centers, churches and even convenience stores. Learn more about #ChoosingWiselyWednesdays and how to request your wallet cards.
New additions: Lists, partners and international efforts
In 2016 the American Dental Association became the first dental organization to publish a Choosing Wisely list, and the American Society of Health-System Pharmacists became the first pharmacy organization to join the campaign.
In addition, several specialty societies released new lists or added new recommendations to their existing list, including: American Society of Breast Surgeons, Society of Surgical Oncology, Society for Maternal-Fetal Medicine, HIV Medicine Association, Obstetric and Neonatal Nurses, and the American Society for Clinical Pathology.
The list of countries that have introduced Choosing Wisely efforts has grown to 18. As the campaign continues to go global, Wales, the UK and Brazil each launched their own Choosing Wisely initiatives in 2016.
Implementations reported in 2016
Johns Hopkins School of Medicine: Chest X-rays fell by 28 percent, with no impact on the ordering of urgent scans, in the intensive care unit (ICU) by removing chest X-rays from the daily morning ordering set, holding discussions during grand rounds, and creating pocket card and workstation reminders.
Department of Medicine at the University of Vermont Medical Center: High-value care projects that relied on a combination of physician education, best practice advisories within EHRs, or redesigned order sets have led to a 72 percent reduction in labs for patients with end-stage renal disease, a 90 percent reduction in DXA scans for patients younger than 65 with low risk for osteoporosis and a 71 percent decrease in portable chest X-rays in intubated patients.
American College of Radiology’s Radiology Support, Communication and Alignment Network (R-SCAN): Baylor Medical College completed the first project through the new R-SCAN platform by using educational materials to reduce inappropriate orders for CT scans for PE clinical indication by half. Radiologists and internists can receive maintenance of certification (MOC) credit for collaborating on these projects.