Reflecting on the First Five Years of Choosing Wisely
On October 24, Health Affairs hosted “Choosing Wisely: Opportunities and Challenges in Curbing Medical Overuse,” a half-day briefing in Washington, D.C. that reflected on the first five years of the Choosing Wisely® campaign. In conjunction with the event, ABIM Foundation published Choosing Wisely: A Special Report on the First Five Years.
In his opening remarks, Health Affairs editor Alan Weil welcomed the group of nearly 250 researchers, clinicians, consumer advocates, educators, Choosing Wisely grantees, journalists and others in attendance. He was joined by Richard J. Baron, MD, ABIM Foundation President and CEO; Susan R. Mende, Senior Program Officer for the Robert Wood Johnson Foundation; and Jessica Rich, Consumer Reports Vice President for Consumer Policy Mobilization, for a conversation about Choosing Wisely.
Dr. Baron began by acknowledging how the campaign originated from ABIM Foundation’s focus on professionalism as a way to improve health care. “Choosing Wisely is the practical expression of the Foundation’s mission,” he said.
The participants agreed that continued conversations about appropriate care have advanced the campaign during its initial five years. These conversations include those between patients and clinicians, among medical specialty society members, and within and between communities.
To discuss what the campaign has accomplished so far, representatives from Choosing Wisely grantee projects—Eric Wei, MD, of Los Angeles County + USC Medical Center; Matt Handley, MD, of the Washington Health Alliance; and Kellie Slate Vitcavage from Maine Quality Counts—shared some of their success stories about reducing pre-operative tests, imaging and inappropriate antibiotics prescribing. Arthur Hong, MD, from the University of Texas Southwestern Medical Center, addressed ongoing challenges of Choosing Wisely, noting his research showed only minimal reductions in imaging for low-back pain.
The next session focused on recent research about Choosing Wisely and the future of the campaign:
- Costs of Care’s Neel Shah, MD, discussed the Health Affairs blog post he wrote with colleagues about making Choosing Wisely central to medical education;
- The Dartmouth Institute’s Alexander Mainor, JD, MPH gave an overview of results from a physician survey, published in Health Affairs, which showed that awareness about the campaign did not substantially increase in recent years, and talked about ways to reverse this trend;
- John Mafi, MD, talked about his recent findings that health services that are low-cost and high-volume account for most of unnecessary health spending; and
- Eve Kerr, MD, MPH, shared strategies on how Choosing Wisely can achieve more in the next five years.
Michael Chernew, PhD, of Harvard Medical School, and Daniel Wolfson, Executive Vice President and Chief Operating Officer of ABIM Foundation, provided reflections at the end of the event. They also co-authored a post on professionalism and Choosing Wisely that was published on the Health Affairs blog.
“We were honored that so many people joined us to discuss Choosing Wisely and share ideas for the next five years of the campaign,” Wolfson said. “The important research from Health Affairs indicates that we have made progress, but that we need to do more to engage patients, clinicians, health systems and medical educators in reducing low-value care. Work on the next phase of Choosing Wisely has already begun.”
New and Continued Partnerships
The Patient-Centered Primary Care Collaborative (PCPCC) and the ABIM Foundation have announced plans to collaborate on developing and implementing effective approaches to engage patients and families in decisions about health services addressed in Choosing Wisely programs. This partnership will leverage PCPCC’s role in the Center for Medicare & Medicaid Services (CMS) Transforming Clinical Practice Initiative to advance patient and family engagement. The goal of the effort is to foster meaningful partnerships among clinicians and patients, families, and community-based organizations to reduce use of opioids, unnecessary antibiotics, and low-value imaging as well as other services that are not necessary, redundant or even harmful.
In addition, the Foundation will continue its successful partnership with AcademyHealth to expand conversations about health care value through the Research Community on Low-Value Care. The community launched in 2016 and now boasts more than 160 members who interact regularly through various virtual and in-person forums to explore future research and interventions to reduce overuse in health care. In the next phase of this partnership, the Foundation and AcademyHealth plan to form at least two thematic groups within the research community to develop collaborative papers about topics such as advancing research methods or ways to design, implement and evaluate system-level interventions to reduce low-value care.
Additionally, the organizations plan to enlarge and diversify the community by including more young professionals and community practitioners. They will also expand efforts to crowdsource new ideas and establish a forum and peer-mentoring program to discuss and overcome shared challenges.
To join the Research Community on Low-Value Care, email RC-LVC@academyhealth.org.
Learning Network Inaugural Fellow
ABIM Foundation partner, Costs of Care, welcomed Arjun Gupta, MD, as its inaugural Teaching Value in Healthcare Learning Network Fellow for 2017–18. Dr. Gupta attended medical school at the All India Institute of Medical Sciences and completed residency in internal medicine at the University of Texas Southwestern (UTSW) in Dallas, Texas. He is currently the Chief Resident for Quality, Patient Safety and High Value Care at UTSW.
“Having received my early medical training in a resource-limited setting during residency, I immediately noticed the ‘waste’ all around me in health care. As a resident at the University of Texas Southwestern, I was fortunate to participate in courses such as our Clinical Safety and Effectiveness Course, American Society of Clinical Oncology Quality Training Program, and Dell Med School’s Discovering Value-Based Health Care modules. As I learned the basic principles of quality improvement and high-value care, I started to see medicine through a different lens. Inspired by Choosing Wisely, my resident colleagues and I began to address the overuse that we saw and our efforts led to multiple publications in JAMA Internal Medicine’s ’Teachable Moments‘ series,” said Dr. Gupta.
“I hope to increase the impact of the Costs of Care/ABIM Foundation Teaching Value in Healthcare Learning Network among trainees—our healthcare leaders of tomorrow—and diversify its focus to encompass multiple specialties. I look forward to entering a national network of stakeholders in the field of value, and being mentored by the best in the field with the ultimate goal to do the right thing at the right time for our patients and their families.”