The Regions Health and Health Care Systems Communities Achieving - - PowerPoint PPT Presentation

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The Regions Health and Health Care Systems Communities Achieving - - PowerPoint PPT Presentation

Nov 28, 2023 118 likes •531 views

9 th Annual MiHIA Conference: The Regions Health and Health Care Systems Communities Achieving Excellence and Accountability January 26, 2018 The e Guide de St Star r of Prof rofess ssion ionali alism sm 3 Fundame damental

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9th Annual MiHIA Conference: The Region’s Health and Health Care Systems “Communities Achieving Excellence and Accountability” January 26, 2018

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10 Commitmen itments ts

  • Professional competence
  • Honesty, confidentiality and

appropriate patient relations

  • Improving quality of care
  • Improving access to care
  • Just distr

strib ibut ution ion of resour

  • urces

es

  • Scientific knowledge
  • Avoiding conflict of interest
  • Professional code of conduct

3 Fundame damental ntal Principle nciples

  • Primacy of patient welfare
  • Patient autonomy
  • Social justice

The e Guide de St Star r of Prof rofess ssion ionali alism sm

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“I would propose that each specialty society commit itself immediately to appointing a blue-ribbon study panel to report, as soon as possible, that specialty's ‘Top Five’ list.”

Howard Brody, MD Medicine's Ethical Responsibility for Health Care Reform — The Top Five List The New England Journal of Medicine, 2010

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April 4, 2012

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Choosing Wisely is an initiative of the ABIM Foundation to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician-led efforts to provide high-value care and help patients make smart, effective choices.

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On the front lines, witnesses to harm

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One e St Story y of Harm --

  • - Dr. Eric

ic Wei

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Ou Our Success cess To Date

  • 80 specialty society partners
  • 535+ recommendations
  • 29 current and former grantees
  • 45+ Choosing Wisely Champions
  • 70+ consumer and employer groups
  • 1,330 journal article mentions in 2016*
  • 19 other countries
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A Grow Growin ing Glo lobal l Move veme ment

Australia, Austria, Brazil, Canada, Denmark, England, France, Germany, India, Israel, Italy, Japan, Netherlands, New Zealand, Norway, Portugal, South Korea, Switzerland, United States, Wales

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Lesson ssons s Learn rned ed

  • Power of messaging and framing
  • Simple rules
  • Engagement and partnership
  • Bottom-up approach with support
  • Need for system and performance

improvement approaches

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Power of Messaging

  • Focus on quality, safety and “do

no harm”

  • Evidence based
  • Within control of specialty
  • Physician and patient lead
  • Transparent process
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Clinical Recommendations Consumer Translations

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Simple Rules

“An implication of Complexity Theory is called Minimum Specifications or ‘Simple Rules.’ An alternative to central planning and control, this approach engages the participants in a system in determining for themselves what actions to take, so long as they work within a set of basic standards.”

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Specialty Controlled Frequently Used or Costly Transparent Process Evidence- Based

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Engagement and Partnership

Patient and Clinician Conversations

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Explored statewide models Enhanced patient-clinician communication 2 point-of-care pilot projects, in English and Spanish

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Physician Perceptions of Choosing Wisely and Drivers of Overuse, Am J Manag Care. 2016;22(5):337-343

“Three-fourths (75.1%) of primary care physicians reported they agreed or somewhat agreed that Choosing Wisely empowered them to reduce use of unnecessary tests and procedures compared with 64.4% of medical specialists and 54% of surgical specialists.”

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As a result of the Choosing Wisely campaign:

  • Most respondents (64.5%) felt more comfortable discussing

low-value services with patients

  • 54.5% reported reducing utilization
  • 52.5% were aware of local efforts to promote the campaign
  • Majority (62.9%) of respondents were able to identify at least

4 out of 5 recommendations.

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“The number of articles on overuse nearly doubled from 2014 to 2015, indicating that awareness of overuse is increasing...”

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Pro roblem em of Ad Adve verse se Eve vents s – Dr. Jay Bhatt

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Bott

  • ttom-Up

Up Approac

  • ach

“This program was different because all of the ideas, which the Choosing Wisely campaign seeded, were generated by physicians in direct patient care.”

Justin Stinnett-Donnelly, MD University of Vermont Medical Center

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Dell ll Medic ical Schoo

  • ol

l – Dr. Chris is Moria iates

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Ou Our New ewest st Init nitiativ ative e in n U.S.

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Scott Weingarten, MD Senior Vice President Chief Clinical Transformation Officer

  • Programmed 180 Choosing Wisely

recommendations into EMR

  • Alerts physicians who attempt to
  • rder test or treatment referenced

by Choosing Wisely

  • Links to society recommendation

and Consumer Reports materials

  • $6 million in annual cost savings in

aggregate from implementing Choosing Wisely recommendations across system

Nee eed d for Syst stem em and nd Perfor

  • rman

ance ce Impr provemen ement t

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Matt Handley, MD Medical Director for Quality KP Washington

Inter ervent ntion ions

  • EMR alerts
  • Clinician performance feedback
  • Compensation tied to appropriate

prescribing

  • Peer comparisons

Results lts

  • 31% reduction in annual paps
  • 33% reduction in inappropriate

antibiotic use

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Results lts

  • 57% reduction in

inappropriate antibiotic prescribing Pre-cataract surgery:

  • 37% drop in chest x-rays
  • 83% decrease in EKG

testing

  • 87% decrease in lab tests

Inter ervent ntion ions

  • Established new clinical

guidelines

  • Changed workflows,

surgery requirements

  • Physician champions
  • Clinical education
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Results lts

  • 70% reduction DEXA scans
  • 67% reduction too frequent Pap tests
  • 14 % reduction in antibiotic prescribing for URIs; down to 26% of patients

Inter ervent ntion ions

  • Clinical pathways in EMR
  • Peer-to-peer training
  • Changes to order sets
  • Provider feedback
  • Patient materials
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Univ

  • iv. of Chic

icago go Medi dicine cine – Dr. Vin ineet Aro rora

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Altering overuse of cardiac telemetry in non-invasive care unit settings by hardwiring the use of American Heart Association Guidelines. (2014)

Interventions

  • Changed all telemetry orders to

include clinical indication

  • Most orders automatically expired at

24 or 48 hours Results

  • 70% reduction in the daily number of

patients monitored

  • Daily cost saving of $13,199
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Inter ervent ntion ions

  • Dissemination of institutional guidelines
  • Changed computerized order entry

Results lts

  • Increased adherence to guideline ordering - 57.1% to

95.5%

  • 66% reduction in tests ordered
  • $1.25 million saved in year 1
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Effecti ective Int ntervention tions

  • Clinician feedback/peer comparisons
  • Clinical decision support
  • Clinical champions
  • Changes in order sets, guidelines and

workflows

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Choosing g Wisely App

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Re Resour

  • urces

s availabl available on the Choosi

  • sing

ng Wis isely ly websit site

www.ChoosingWisely.org/Resources

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@ABIMFoundation #choosingwisely @WolfsonD