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Sampson Law, Ashi Mehta, Eileen Patterson, June Cooper, John Lester, Anthony Train, Shawn Dowling, Katrina Nicholson, Kelly Burak
Using Facilitated Audit & Feedback
to Support Choosing Wisely Initiatives
in Primary Care Networks
GoalsSupport individual physicians & Primary Care Networks to evaluate the appropriateness of their screening & ordering of tests related to three Choosing Wisely topics:
● Pap smear testing● Bone mineral density scans● Lumbar spine imaging
1. Collaboration
Primary Care Networks
PhysicianLearningProgram
Audit & feedback
Data reports
Facilitated multi-disciplinary sessions
Physician champions
PCN engagement
ChoosingWiselyAlberta
Planning, facilitation
Change plans
Implementation
TowardOptimizedPractice
PCN-level aggregatedata
Physician patientpanel reports
Health QualityCouncil ofAlberta
Subject matter experts
Screening and othersupport programs
AlbertaHealthServices
Identify barriers & enablers to best practice.
2. Interactive Learning Workshop
Primary Care Networks selected the Choosing Wisely topic(s) that were relevant & important to their physician members.Several provincial healthcare improvement agencies/initiatives co-developed a unique, multi-faceted educational workshop for primary care phycians & their teams.
Participants consented to receive their own confidential practice data reports from PLP or HQCA, then attended a 2.5 hour workshop.
Didactic Lecture45 min session from subject matter expert● updates to guidelines● evidence-based best practices● use case examples
Individualized Practice ReportsPhysicians received reports with individualdata & peer comparators showing their:● pap smear testing rates ● # of repeat DEXA scans ordered● # of CT scans and MRIs ordered on the
lower back
Facilitated Group Discussions● disuss the data ● identify opportunities for improvement● identify barriers & enablers to
achieving best practice
Action PlansParticipants developed change plans at individual, clinic, & PCN level, then made personal committments to change their practice
Participant Satisfaction5 PCNs participated in 7 events
4. Results
would recommend theevent to a colleague95.9%
felt the event was valuable90.0%
felt the event supported PCN improvement87.8%
said it helped set & evaluate personal goals90.2%
physicians participants207
allied health professionals, QI staff, and administrator participants60
data reports delivered by the HQCAwith metrics on CW topics2500
individualized data reports delivered182
felt the data taught them something about their practice88.7%
3. Data
NUMBER OF LUMBAR SPINE CT & MRIs ORDEREDAlberta
Don’t screen women with Pap smears if under 21 years of age or over 69 years of age
Don’t repeat DEXA scans more oftenthan every 2 years
Don’t do imaging for lower-back painunless red flags are present
Cervical Cancer Screening Osteoporosis Screening - DEXA Scans Lumbar Spine Imaging
70+ years15-20 years
Alberta16.9%
Alberta14.6%
North
South South9.4%13.6%
North14.0%20.8%
Edmonton Edmonton22.3%14.7%
Central Central13.6%16.3%
Calgary Calgary15.9%11.8%
25%
0%
3-YEAR CERVICAL CANCER SCREENING RATES (2012-2014)Shows over-screening in women under 21 & over 69
REPEAT DEXA SCANSAlberta 2015
REPEAT DEXA SCANSby zone
Alberta20.9%
South20.4%
North14.0%
Edmonton21.3%
Central15.7%
Calgary19.3%
25%
0%
20.9%65,922
79.1%249,288
< 2 years > 2 years
5. Participant Benefits● learning credits, workshops are CFPC Mainpro+ certified
(5 certified group learning credits)
● participants can claim additional self-learningcredits from CFPC:
● opportunity for self-reflection
● goal setting & action plan● ongoing implementation support
Participants receive on-going support from the PCNs Improvement Facilitators & other program partners
● physicians work with their teams to develop improvement plans
Linking Learning to Assessment(6 certified credits)
Linking Learning to Practice(5 certified credits)
Support development of change action plansfor improvement
1
2
3Contact [email protected] to sign your PCN up for the initiative
40000
30000
2011 2012 2013
# of
sca
ns o
rder
ed
Year2014 2015 2016
20000
10000
0%
CTMRI
18219
20354
6403
2011222321 22171 20162
51944576
24793
59775960