Patients can be harmed by tests and treatments that may not benefit them clinically. This harm can be physical, financial or emotional. However, for many the harms from overuse are not always the dominant thought when ordering a test or treatment. While data is integral to showing there is an overuse issue, patient stories help bring data to life. The MacColl Center for Health Care Innovation Safety Net Value Champions Fellowship emphasized collecting and using stories to engage clinicians in overuse projects.
Patient stories of overuse can be gathered in informal and formal ways. The fellows collected stories through patient surveys, focus groups, discussions with colleagues, personal experiences and even patient complaint forms. Here are a few of the stories and how fellows used them in their project:
- Lauren D. Demosthenes, MD, an OBGYN at Prisma Health-Upstate in Greenville, South Carolina, launched a project to transition women to telehealth and remote monitoring for post-partum blood pressure checks. She was inspired to create the project by a story she heard on NPR. A new mother discussed the difficulty of finding child care for her new baby and her toddler and of arranging with her husband to use the family’s single car to travel to the hospital for a blood pressure check. The appointment was a financial hardship for the family and presented transportation difficulties since the family lived in a rural area where the nearest hospital was a significant distance. This story helped convince hospital leaders that the project was worth piloting. Once the project launched, Dr. Demosthenes recruited medical students to conduct a short survey with current new mothers. The residents asked patients whether they preferred in-person or remote visits and about barriers associated with both options. Fifteen of 16 new mothers said it would be easier to do the check remotely, and all said they had smart phones with unlimited text messaging. As the project progressed, several colleagues suggested that patients really prefer in-person visits; she was able to share the survey results. The results also helped confirm her commitment to the project because she was confident she was helping new mothers access more convenient care and improving follow up for pregnancy associated hypertension.
- Elizabeth Vossenkemper, MSN, RN, CPNP-PC, a pediatric nurse practitioner with Tri-Cities Community Health in Pasco, Washington, used focus groups to gather stories. She wanted to launch a project to reduce low value care (LVC), but the Federally Qualified Health Center where she worked had not focused on LVC and she was not an established leader in quality improvement initiatives. She started with a ‘low-hanging fruit’ project to reduce patient use of over-the-counter cough medicine for upper respiratory infections. There is no evidence cough and cold medications offer relief or shorten the duration of a URI and they can have serious side effects. She heard from her colleagues that patients would be upset because they came in and got nothing, so she organized a focus group to find out why parents bring their kids in for a cold. Patients said they wanted the clinician’s advice or opinion; they wanted to make sure their children’s condition was not serious and to do the right thing for their child. Armed with this information, Ms. Vossenkemper created URI symptom kits that included honey, a nasal aspirator, tissues and tips to help reduce symptoms and determine whether to seek emergency care. The focus groups helped her convince her colleagues that patients would welcome this alternate approach, and the URI symptom kits were popular with both clinicians and parents.
Compelling patient stories on overuse may not come as easily as dramatic stories about access to care or care mismanagement. However, stories can be gathered by asking patients for their input. As one value champ put it, “It was so much easier to ask the patient what they wanted than trying to imagine what they wanted.”