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Tests, Treatments and Procedures;
When Less is MoreNameSiteDate
Choosingwiselycanada.orgTwitter: @ChooseWiselyCA | Email:
$$
Fear of litigation
Referring doctor
wants it
Better to get a test than
“do nothing”
I’ve always done this
Patients want it
New tests are
good
Choosingwiselycanada.org
CWA Principles
Start small, learn as we go
Coordinate partners, physician/ patient input
Use data to be effective, improvement methods to sustain
Patient centered, optimal use focus
Show tangible success
Choosingwiselycanada.org
Three Levels of ImplementationC. PCN Demo (Low Back Pain)
B. Partner Priorities (Minor Head Injury, LBP, Transfusions, Headache)
A. All 102 Topics (17 national societies)
Choosingwiselycanada.org
A. All TopicsPublic/Patients
• AMA Patient Portal website
• HUTV for health organizations
• Build on CWC media, posters, and pamphlets
Providers
• Present provincial baseline statistics
• Provider practice data for self-reflection
• Develop change supports; EMR, KT, Care Options …
Choosingwiselycanada.org
Resources
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Specific Topics• Data Support• TOP CPG• CWC Patient Pamphlet• ACFP Tools for Practice
General CWC Supports• CWC Patient Pamphlet
– Think Again• CME: https
://www.mdcme.ca/courseinfo.asp?id=155
albertadoctors.org/choosingwisely
Topic Alberta Partnership ProjectsLow Back Pain • Bone /Joint SCN via PRIHS I: Spine Access Alberta
• CWA Demo Project
Minor Head Trauma
• Emergency SCN via PRIHS I: Improving the Stewardship of DI Resources in AB Emerg.Depts. (Minor Head Trauma and Pulmonary Embolism)
Vitamin D • Implemented April 1st, 2015
Red Blood Cell Transfusion
• PRIHS II: Upper GI Bleed; (Transfusion)
Uncomplicated Headaches
• Looking for implementation partners
B. CWA Partner Priorities
Choosingwiselycanada.org
C. Demo Project: Low Back Pain
When it came to lower-back MRIs; - about 34 per cent of those tests ordered by family
doctors were considered appropriate. - Less than 50 of MRIs ordered by neurologists and
orthopedic surgeons had value. - Neurosurgeons had a higher rate of pegging a test’s
value, at 75 per cent.-Emery D, Feasby T, 2013, JAMA Internal Medicine
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Choosingwiselycanada.org
PCN Demonstration- Review ordering patterns- Gather patient and physician input/themes- Providers, patients and PCN plan changes for improvement
- Point of care support (EMR, CPG, data info …)- Informed patients (pamphlets, HUTV …) - Care options (physio, standard practices, team
processes …)- Coordinated services (referral issues … )
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