addressing appropriateness: exploring the "how to" essentials for implementation of a...
TRANSCRIPT
Addressing Appropriateness: Exploring the “How To” Essentials for
Implementation of a Choosing Wisely Initiative
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Introductions
Appropriateness / Choosing Wisely
Exercise – Identifying Potential Projects
Exercise – Project Design
In closing…
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Your Presenters: ◦ Dr. Bruce Forster ◦ Dr. Jeff Coleman ◦ Dr. Vivian Chan ◦ Darcy Houston
Relationships with Commercial Interests: ◦ Dr. Bruce Forster
Other - an equity position in a private imaging centre in Vancouver BC. The potential bias is managed by full disclosure.
◦ Darcy Houston Other – Employee of Business Services & Transformation, Ministry of
Health. The potential bias is managed by full disclosure.
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Involve Patients/Public Advisors
Not all interventions provide the same effectiveness
Not “one size fits all” (context)
Confidence to undertake an appropriateness project
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Source: The BC Health Quality Matrix
Other considerations beyond clinical –
psychological, emotional
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Brownlee et al. (2017) Lancet, Right Care Series 6
Worldwide, >6 million unnecessary Caesarian sections annually
Worldwide, >500,000 cases of thyroid cancer have been over-diagnosed unnecessary treatment
Around 30% of colonoscopies in USA are inappropriate based on clinical guidelines
2012 estimate suggests overtreatment accounts for ~$270 Billion in USA medical spending (~10% of annual health spending)
Lown Institute: (2017 Jan, 23) http://lowninstitute.org/news/right-care-series
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Defensive medicine
Choosing Wisely Canada
Right Care
Overuse
Underuse
Misuse
Over-diagnosis
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Things physicians and patients should question Developed by Canadian national societies Tests and treatments commonly used, but not
supported by evidence, with potential for harm Latest – Nursing, long-term care http://www.choosingwiselycanada.org/recommendations/
Toolkits 6 Choosing Wisely (CW) toolkits online Developed by clinicians Based on successful CW implementation http://www.choosingwiselycanada.org/in-action/toolkits/
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In your context (facility, practice, etc.): ◦ E.g., where is there unnecessary care? ◦ E.g., where is there waste? ◦ E.g., where could Choosing Wisely create benefits?
5 minutes to brainstorm ideas
Table groups: Pick 1 example of inappropriateness to report out on
This may be your Choosing Wisely project…
Go!
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Time’s Up!
What was the top choice at your table?
TIP: Take a picture of your flip chart so you have a record of all the ideas your group generated…
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Use the pre-printed flipchart 1. What is your project? 2. Who will be on your team? 3. What will you measure? 4. What will help your project succeed? 5. What barriers or pitfalls might you face? 6. What is your goal? 7. What resources are in your toolkit?
10 minutes to fill in template
Go!
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Time’s Up!
What barriers or pitfalls did you identify?
◦ How might you get around those barriers?
What are some resources you require?
How will you know you have succeeded?
What are you most excited about?
TIP: Take a picture of your flip chart so you have a record of all the ideas your group generated…
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Visible, overt support of senior leadership
Patient / public involvement
Allies and champions
Clinical input
Resources – IT support, analytics
Baseline / Intervention / Outcomes
Unintended consequences
Accountability
Rapid turnaround and decision making
Your ideas?
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Members meet to
work out
(6-9 months)
Confirm problem
definition &
appropriateness
criteria/red flags
in literature
Confirm
methodology of
data collection
(baseline data)
Determine
evaluation
metrics
Review data to
scope
appropriateness
at site level
Develop solution
•Patient material
•Physician material
Implement
solution and
track progress
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How do you sustain the momentum? ◦ Talk to your peers about appropriateness
◦ Talk to your leaders about getting a project going
What we heard from you ◦ What you are concerned about
◦ What you are excited about
Next steps
Appropriateness exercise template
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Please complete an evaluation before you go
Questions? Contact us:
Bruce [email protected]
Jeff [email protected]
Vivian [email protected]
Darcy [email protected]
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