Choosing Wisely: an International Campaign to Decrease Unnecessary Medical Care

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Choosing Wisely: An international campaign to decrease unnecessary medical care Webinar Objectives 1. To review the international evidence of the magnitude of overuse of technology 2. To describe the Choosing Wisely campaign in Canada and internationally 3. To share the emerging evidence of impact of the campaign on overuse About Choosing Wisely ™ Optimizing value and eliminating waste in medical care is a worldwide concern. In some countries, evidence shows that a significant amount of medical spending is Presenter unnecessary and does not add value in care.[i] Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests and Dr. Wendy Levinson, treatments and make smart and effective choices to ensure high quality care. Chair of Choosing Wisely Choosing Wisely Canada leads an international community, made up of countries from Canada & Professor of around the world who are implementing similar programs in their respective Medicine at the countries. At present, this community includes representation from Australia, Austria, University of Toronto. Brazil, Denmark, England, France, Germany, India, Israel, Italy, Japan, Netherlands, India, New Zealand, South Korea, Switzerland, United States and Wales. Dr. Levinson is a national and international expert Choosing Wisely Canada is organized by a team of leading Canadian physicians, in partnership with the Canadian Medical Association. More than 45 Canadian medical in the field of physician- specialty societies are at various stages of engagement in the campaign. To date, over patient communication 170 clinician recommendations of “Things Clinicians and Patients Should Question” and, in particular, on the have been released across participating specialties. disclosure of medical http://www.ChoosingWiselyCanada.org. errors to patients. [1] Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Yong PL, Saunders RS, Olsen LA, editors. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington (DC): National Academies Press (US); 2010. Webinar Details To Register Thursday 14 April 2016 Go here and click “Register” 9:00 – 10:30 am EST (Toronto) https://goo.gl/x8D8GO Convert to local time: http://www.timeanddate.com/worldclock/converter.html Or contact Tara Schuller at [email protected] Free for INAHTA Members On the Internet, using WebEx .

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STARTER KIT for Your Choosing Wisely Campaign INTRODUCTION
ChoosingChoosing WiselyWisely InternationalInternational LearningLearning NetworkNetwork STARTER KIT for your choosing wisely campaign INTRODUCTION Thank you for your interest in joining the Choosing Wisely International Learning Network. Become a part of the growing international movement of physician leaders combatting medical overuse and ensuring high quality care. What is Choosing Wisely®? Choosing Wisely®, first launched in the United States in 2012 by the ABIM Foundation and Consumer Reports, has been adopted by countries across the world. Campaigns encourage clinicians and patients to engage in evidence- based conversations about what tests and treatments may not benefit them and could cause ?harm. This guide is intended to provide basic information and tools to help you start your Choosing Wisely campaign. You can then ABOUT tailor your campaign to your local circumstances this starter kit and creative vision. Included in the Starter Kit are: Core principles of a Choosing Wisely 1 campaign Links to current Choosing Wisely 2 campaigns across the world Key publications to guide the 3 implementation of your campaign 4 Contacts to connect to for support LET’S GET STARTED. CORE PRINCIPLES of a Choosing Wisely campaign COREphysician-led PRINCIPLES patient-centered multiprofessional evidence-based transparent PHYSICIANPHYSICIAN- 1 LEDLED The campaign must be physician- led (as opposed to payer/ government led). This is important to building and sustaining the trust of clinicians and patients. It emphasizes that campaigns are focused on quality of care and harm reduction, rather than cost reduction. PATIENTPATIENT- 2 FOCUSEDFOCUSED The campaign must be patient- focused and involve efforts to engage patients in the development and implementation process.
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Patient & Public Engagement in Choosing Wisely
PATIENT & PUBLIC ENGAGEMENT IN CHOOSING WISELY TOOLKIT | VERSION 1.0 Editors Anna Kurdina Karen Born Wendy Levinson Contributors Marco Bobbio Stephanie Callan Angela Coulter Moriah Ellen Amy Ma Robyn Lindner Paul Myres Ramai Santhirapala Todd Sikorski Choosing Wisely Canada receives support from The Commonwealth Fund, Bertelsmann Stiftung and Korea University to coordinate Choosing Wisely International. For more information, please contact [email protected] 2 CONTENTS BACKGROUND 4 Executive Summary 4 About Choosing Wisely International 7 Patient and Public Engagement 7 Framework 7 PARTNER 8 Case 1.1 - US: Partnership with Consumer Reports and 70 Other Organizations 9 Case 1.2 - Norway: Partnership with the Norwegian Patient Association 10 Case 1.3 - Canada: Patient Advisor Roles 11 Case 1.4 - Japan: Engagement Strategies with the Public nd Media 12 Case 1.5 - Italy: Partnerships with Altroconsumo and Partecipasalute 13 Case 1.6 - Australia: Consumer Stakeholder Roundtables 14 ENGAGE 15 Case 2.1 - New Zealand: Consumer Commentary Sessions 15 Case 2.2 - Canada: Canadian Rheumatology Association List 18 Case 2.3 - Israel: Recommendations from the Association of Family Physicians 19 Case 2.4 - UK: Specialty Societies Involving Patients 20 Case 2.5 - US: Tools to Engage Patients in QI Initiatives 21 Case 2.6 - Wales: “What matters to you/me” Day 22 Case 2.7 - Australia: Consumer Working Group 23 Case 2.8 - US: Community Conversations About Overuse 25 INFORM 26 Case 3.1 - Canada and New Zealand: Survey Data on Patient Attitudes
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Implementing Choosing Wisely Principles in a Service This Guide Covers
IMPLEMENTING CHOOSING WISELY PRINCIPLES IN A SERVICE THIS GUIDE COVERS This guide is intended to provide basic information and tools to help you start your Choosing Wisely campaign. You can then tailor your campaign to your local circumstances and creative vision while following the core principles of a Choosing Wisely campaign. 1. What is Choosing Wisely? 2. The rationale behind the campaign 3. Core Principles of a Choosing Wisely Campaign 4. Choosing Wisely Internationally 5. Choosing Wisely in New Zealand 6. Getting started 7. Measuring your performance 8. Changing the culture 9. Factors for success 10. Involving patients and consumers 11. Contacts and resources 2 WHAT IS CHOOSING WISELY? Choosing Wisely is a campaign targeting the reduction of low-value health care by encouraging conversations between health professionals1 and consumers2 / patients, so they: • Are fully informed by the evidence about their treatment options. • Are able to make the right choices for themselves. • Do not undergo tests, treatments or procedures which are unnecessary. The focus is on the health professional and consumer working together to improve the quality of care that is delivered. The Council of Medical Colleges (CMC) is facilitating the Choosing Wisely campaign as part of its commitment to improving the quality of healthcare in New Zealand of care for consumers/patients. The programme encourages health professionals to hold conversations with consumers/patients to ensure they understand the evidence relating to the care being proposed, so they can make wise choices. Overseas research has shown that effective Choosing Wisely programmes are clinician-led and that effective consumer/patient engagement is necessary if the programme is to be successful.
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Spreading the Word of Choosing Wisely at NYGH Laboratory Medicine
Spreading the word of Choosing Wisely at NYGH Laboratory Medicine Manuel Giraldo. MHA, CHE, BSc. MLT Pathology and Core Laboratory, Manager LABCON-Ottawa-May 26 , 2018 Will review…. • Backgrounder • Choosing Wisely Campaign at NYGH • Laboratory Pre and Post-CWC Implementation • Challenges/Keys to success • Benefits/New lab initiatives 2 3 Choosing Wisely Canada 4 Choosing Wisely Canada Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests, treatments and make smart and effective choices to ensure high-quality care. • Began in April 2014 5 6 A GROWING GLOBAL MOVEMENT Canada Japan South Korea United States Isarael India Italy Australia Brasil New Zealand Choosing Wisely US report. 7 Canadian Association of Pathologists Five Things Physicians and Patients Should Question Don’t perform population based screening for 25-OH-Vitamin D deficiency. Vitamin D deficiency is common in many populations, particularly in patients at higher latitudes, during winter months and in those with limited sun exposure. Over the counter Vitamin D supplements and increased summer sun exposure are sufficient for most otherwise healthy patients. 1 Laboratory testing is appropriate in higher risk patients when results will be used to institute more aggressive therapy (e.g., osteoporosis, chronic kidney disease, malabsorption, some infections). Don’t screen women with Pap smears if under 21 years of age or over 69 years of age. Follow provincial guidelines for cervical cancer screening. Screening before the recommended age of initiation (age 21 in most provinces), 2 screening women over the age of 69, or annual screening is not recommended. Avoid routine preoperative laboratory testing for low risk surgeries without a clinical indication.
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Foundations of Resource Stewardship
Communicating with patients and families about medically unnecessary tests and treatments Preceptor Guide Part of the CanMEDS Resource Stewardship Curriculum Toolkit Series Editors Geetha Mukerji, MD, MSc, FRCPC Division of Endocrinology & Metabolism Women’s College Hospital Institute of Health Policy, Management and Evaluation University of Toronto Toronto, Ontario Adina Weinerman, MD, FRCPC Department of General Internal Medicine Sunnybrook Health Sciences Centre Toronto, Ontario Series Editor Chris Hillis, MD, MSc (QI/PS), FRCPC Department of Oncology, McMaster University Hamilton, ON 1 Copyright © 2017 The Royal College of Physicians and Surgeons of Canada The Royal College of Physicians and Surgeons of Canada 774 Echo Drive Ottawa, Ontario K1S 5N8 Canada Telephone: 613-730-8177 Toll-Free: 1-800-668-3740 Fax: 613-730-3707 Website: royalcollege.ca/canmeds E-mail: [email protected] Copyright © 2017 The Royal College of Physicians and Surgeons of Canada. All rights reserved. This material may be reproduced in whole or in part for educational, personal or public non-commercial purposes only. Written permission from the Royal College is required for all other uses. How to reference this document: Hillis C, G Mukerji and A Weinerman, editors. 2017. Communicating with patients and families about medically unnecessary tests and treatments. Preceptor Guide. Part of: The CanMEDS Resource Stewardship Curriculum Toolkit Series. Ottawa: The Royal College of Physicians and Surgeons of Canada. 2 Copyright © 2017 The Royal College of Physicians and Surgeons of Canada PREAMBLE The focus of this power point presentation is on teaching residents communication skills associated with resource stewardship. More specifically, it will provide a framework for how to communicate with patients and families that are requesting a medically unnecessary test/treatment.
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Supplemental Digital Appendix 1 Choosing Wisely Canada CFMS
Lakhani A, Lass E, Silverstein WK, et al. Choosing Wisely for Medical Education: Six Things That Medical Students and Trainees Should Question. Acad Med. Supplemental Digital Appendix 1 English-Language Version of Student Questionnaire Used in the National Medical Student Consultation on Candidate Recommendations Choosing Wisely Canada CFMS Recommendations Background: One thing you may not learn in medical school is that up to 30% of tests and treatments that physicians order are unnecessary. Unnecessary tests, treatments, and procedures are not only clinically useless, but they also potentially expose patients to harm. Choosing Wisely Canada is a campaign to help patients and physicians engage in conversations about unnecessary tests, treatments and procedures. Choosing Wisely Canada has partnered with forty-nine specialty societies to develop lists of “Five Things Physicians and Physicians Should Question” to reduce inappropriate use of healthcare resources. We, as the future physicians of Canada, have an important voice in this movement to reduce unnecessary care. Choosing Wisely Canada has broad national support from practicing physicians - and now it’s YOUR turn! Choosing Wisely Canada has partnered with the Canadian Federation of Medical Students (CFMS) to create our very own list of recommendations for medical students. We hope that this list will highlight the challenges that medical students face in training when trying to learn how to use healthcare resources appropriately. A task force has developed a preliminary list of 10 candidate recommendations. WE WANT YOUR INPUT to create a final list of “Five Things Medical Students Should Question”. By filling out this short 5-minute survey, you can be a part of this movement to reduce unnecessary care.
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Confidential: for Review Only Advancing Choosing Wisely Campaigns: There Is More to Do
BMJ Confidential: For Review Only Advancing Choosing Wisely Campaigns: There is More To Do Journal: BMJ Manuscript ID BMJ-2019-051921 Article Type: Analysis BMJ Journal: BMJ Date Submitted by the 30-Jul-2019 Author: Complete List of Authors: Born, Karen; University of Toronto Faculty of Medicine, Institute of Health Policy, Management & Evaluation Levinson, Wendy; St Michaels Hospital, Inner City Health Research Unit overdiagnosis, overuse, Choosing Wisely, implementation science, de- Keywords: implementation https://mc.manuscriptcentral.com/bmj Page 1 of 8 BMJ 1 2 3 1 4 5 2 6 3 Title: 7 8 4 Advancing Choosing Wisely Campaigns: There is More To Do 9 5 10 11 6 12 7 Confidential: For Review Only 13 8 Karen Born 1 14 1,2 15 9 Wendy Levinson 16 10 17 11 18 12 1 Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, 19 13 Faculty of Medicine, University of Toronto. Toronto, Ontario. Canada. 20 2 21 14 Department of Medicine, University of Toronto. Toronto, Ontario. Canada. 22 15 23 16 Correspondence to: 24 17 Karen Born, PhD 25 18 Institute of Health Policy, Management and Evaluation 26 27 19 University of Toronto 28 20 Health Sciences Building 29 21 155 College Street, Suite 425 30 22 Toronto, ON M5T 3M6 31 32 23 Email: [email protected] 33 24 Phone: 416 254 7505 34 25 35 26 Word count: 2272 36 27 References: 22 37 38 28 39 29 40 30 Standfirst 41 31 Choosing Wisely campaigns worldwide have galvanized physician leadership on overuse by 42 32 issuing recommendations and raising public awareness.
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Choosing Wisely Concept Has Universal Appeal
News CMAJ Choosing Wisely concept has universal appeal t began in the United States in 2012. Canada joined in 2014. It has since I spread to Japan, Brazil, France, Germany, Israel, Australia and many other countries. The concept behind the Choosing Wisely campaign — that more health care isn’t always better health care — appears to have universal appeal. And that’s a rare thing on the international health care scene. “It transcends all these different health care systems and different pay- ment schemes because it resonates with doctors about the core essence of what it is to work with patients, and that is the same in every country,” says Dr. Wendy Levinson, chair of Choosing Wisely Canada and a pro- fessor of medicine at the University of Toronto. “That is the amazing part of skynesher/iStock this story. Give me another example Physicians in many countries agree that reducing the use of some medical tests, such as where there has been so much interest MRI scans, is a good idea. across countries in anything about changing health care systems.” The success across borders of tiums held over the past three years in If there were international discus- Choosing Wisely is even more amaz- Amsterdam, London and Rome. It is sions about how best to fund health ing, says Levinson, when you consider the Canadian team that pushed for the care, for example, there would likely the financial incentives for physicians Commonwealth Fund to include ques- be many different opinions. Talks — there are none. No one is getting tions on overuse in its surveys.
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'Choosing Wisely': a Growing International Campaign
Downloaded from http://qualitysafety.bmj.com/ on November 11, 2015 - Published by group.bmj.com BMJ Quality & Safety Online First, published on 31 December 2014 as 10.1136/bmjqs-2014-003821 NARRATIVE REVIEW ‘Choosing Wisely’: a growing international campaign Wendy Levinson,1 Marjon Kallewaard,2 R Sacha Bhatia,1 Daniel Wolfson,3 Sam Shortt,4 Eve A Kerr,5 On behalf of the Choosing Wisely International Working Group ▸ Additional material is ABSTRACT even clinically indicated, the fundamental published online only. To view Much attention has been paid to the quality improvement target becomes please visit the journal online (http://dx.doi.org/10.1136/bmjqs- inappropriate underuse of tests and treatments unnecessary care itself. 2014-003821). but until recently little attention has focused on Eliminating unnecessary medical care and the overuse that does not add value for patients optimising value has received increasing 1Department of Medicine, University of Toronto, Toronto, and may even cause harm. Choosing Wisely is a attention from health systems in the past Ontario, Canada campaign to engage physicians and patients in decade. Critical evidence shows that in 2 Dutch Association of Medical conversations about unnecessary tests, some countries, particularly the USA, an Specialists, Utrecht, treatments and procedures. The campaign began estimated 30% of all medical spending is The Netherlands 3ABIM Foundation, Philadelphia, in the United States in 2012, in Canada in 2014 unnecessary and does not add value in 56 USA and now many countries around the world are care. Some countries have appointed task 4 Canadian Medical Association, adapting the campaign and implementing it. forces to identify ways to eliminate waste in Ottawa, Canada 5 This article describes the present status of healthcare, seeking to deliver quality care at VA Center for Clinical Management Research, VA Ann Choosing Wisely programs in 12 countries.
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Can We Lower Low-Value Care? Policy Measures and Lessons in Australia
Attachment G4 WORKING PAPER - DO NOT CITE OR DISTRIBUTE WITHOUT PERMISSION OF THE AUTHORS CAN WE LOWER LOW-VALUE CARE? POLICY MEASURES AND LESSONS IN AUSTRALIA, CANADA, ENGLAND, FRANCE, AND GERMANY Reinhard Busse, Technische Universität Berlin Verena Vogt, Technische Universität Berlin Adam Elshaug, The University of Sydney Tai M Huynh, University Health Network, Toronto Wendy Levinson, University of Toronto Hugh Alderwick, The King’s Fund Kalipso Chalkidou, NICE Isabelle Durand-Zaleski, Hôpital Henri Mondor Prepared for: The Commonwealth Fund 2015 INTERNATIONAL SYMPOSIUM ON HEALTH CARE POLICY 1 Attachment G4 WORKING PAPER - DO NOT CITE OR DISTRIBUTE WITHOUT PERMISSION OF THE AUTHORS INTRODUCTION In efforts to restrain the growth of health care expenditures without compromising health status or quality of care, many countries are searching for ways to reduce the use of health care technologies and services that provide little or no health benefit. Internationally, the problem is described various ways; equally, the measures to address it are described various ways, reflecting disciplinary background (e.g., clinicians vs. policymakers), focus (individual patients vs. population), time, fashion, country, and/or whether costs are explicitly taken into account. The oldest trace goes back to the UK, where Archie Cochrane published his landmark book, Effectiveness and Efficiency: Random Reflection on Health Services, in 1972, “which showed that decisions about which technologies to implement ought to be guided by evaluation, especially randomized controlled trials (RCTs).”1 While mainly unnoticed at the time of publication, it was the foundation for evidence-based medicine (EBM), “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients,”2 initiated in the 1980s in Canada, and the Cochrane Collaboration, founded in 1993.
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Wendy Levinson, MD Professor of Medicine, University of Toronto Chair, Choosing Wisely Canada Health Quality Indicators Expert Meeting May 20Th, 2015
Wendy Levinson, MD Professor of Medicine, University of Toronto Chair, Choosing Wisely Canada Health Quality Indicators Expert Meeting May 20th, 2015 What is unique about Choosing Wisely® ? • Clinician led • Bottom up approach • Focused on common clinical conditions • Both primary care and specialties • Simple • Remarkably rapid uptake Choosing Wisely Canada (CWC) is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. Facts • Choosing Wisely® campaign began in 2012 in US; 70 medical societies are participating • Choosing Wisely Canada launched in April 2014 • More than 45 national specialty societies engaged • Choosing Wisely® efforts are also present in countries like Australia, Denmark, England, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, South Korea, Switzerland, Wales, Brazil. Levinson W, et al. Choosing Wisely: A Growing International Campaign. BMJ Quality & Safety. 2014. Campaign approach • Societies develop lists Physicians • Disseminate through multiple channels • Develop patient materials Patients • Disseminate broadly through multiple channels • Coordinated approach toward media Media • Multiple voices, a common message • Work through health care stakeholder Stakeholders organizations to implement and support adoption The Implementation Spectrum ENGAGEMENT & EDUCATION QUALITY IMPROVEMENT HARD CODING o Leadership engagement o QI projects o Policy
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LEADING and IMPLEMENTING CHANGE Abstract Book
In partnership with the Canadian Medical Association 2018 National Meeting LEADING AND IMPLEMENTING CHANGE Abstract Book LEAD SPONSOR SPONSORS • Engage with the Choosing Wisely community in an energized exchange of ideas Overall on overuse Program • Hear about practical and implementable strategies for reducing overuse, and Goals understand their impact • Network with colleagues who share your passion Overall At the end of this meeting, participants will be able to: • Exchange knowledge and best practices for reducing low-value care within the Learning clinical setting Objectives • Learn about strategies to measure and evaluate interventions • Acquire tools and skills of implementation science as they relate to reducing low-value care STUDY CREDITS College of Family Physicians of Canada – Mainpro+: This Group Learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by Continuing Professional Development, Faculty of Medicine, University of Toronto for up to 6.0 Mainpro+ credits. Royal College of Physicians and Surgeons of Canada – Section 1: This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, approved by Continuing Professional Development, Faculty of Medicine, University of Toronto. You may claim a maximum of 6 hours (credits are automatically calculated). PAGE 2 Contents Program Goals and Objectives 2 Chair’s Foreword 6 Agenda 7 DEPRESCRIBING Promoting
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