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Tests, Treatments and Procedures;

When Less is MoreNameSiteDate

Choosingwiselycanada.orgTwitter: @ChooseWiselyCA | Email:

info@choosingwiselycanada.org

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$$

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 …

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Patient Key Messages

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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Don’t do imaging for lower-back pain unless red flags are present.

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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albertadoctors.org/choosingwisely

Let’s talk …

Disseminate CWA topics and pamphlets

Choose a CWA topic focus

Implement changes for healthy conversations