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‘More Is Not Always Better’ for Medical Imaging
A5: The Goldilocks Principal: Providing Care That’s Just Right
Jennifer Furtado Consultant, Medical Quality Improvement Medical Affairs Island Health
Disclosure
I have no affiliations (financial or otherwise) with a commercial organization
A patient’s story
GP Orthopedic specialist
MRI CT
$ 330 $ 200
Wait time ~ 340 days Wait time ~ 155 days
Radiation = ~ 0.2 mSV (equivalent to ~ 200 X-rays)
No change in treatment/diagnosis
Perhaps….
‘More Is NOT Always Better’ in Healthcare
Appropriateness Acceptability
Accessibility
Safety
What are the risks associated with doing
the study or NOT doing the study?
What are other options?
How will the results influence treatment
options?
Physicians are saying…
Ordering physicians
48% physicians requested more support/tools to help make decisions about which services were appropriate for their patients (CMA survey, 2016)
Receiving orderings
“Not sure which test would be the best to
elucidate certain problems”
(GP, Divisions of FP)
“With some of the newer imaging I am not always aware of the best test to do”
(GP, Divisions of FP) “I see histories/reason for exam not appropriate for the exam ordered.” (Island
Health)
Why is this happening
In-appropriateness rates vary 2 - 13.6%
Consistent barriers reported
Lack of
Training or Experience Growth of medical imaging Access to guidelines Experience to specific patient group
and….
…Culture
Physicians’ Perceptions • Potential Litigation
• Comfort in affirming results
Patients’ Perceptions • Limited understanding of risk
factors • Need to ‘get something’
1/3 physicians self-report they acquiesce to patients’ request for tests even when they know they are not necessary (Professionalism in Medicine 2007 national survey)
The Choosing Wisely approach
AIM - To promote communication between
physicians (GP↔ SP↔ SP) AND their patients
Core competencies: ‘Professionalism in Action’
• Maintaining & supporting best practices
• Involving patients in shared decision-making
• Promoting responsible use of finite resources
Where we are at
Determine focus area
Develop ‘Flags’
Develop change ideas
Implement ideas
Evaluate
Established partnership with Shared Care Formation of an advisory panel 5 GPs 4 Radiologists 3 Emergency Medicine 3 Administration
Physicians ID area of improvement CT-PE & CTA
We are here
Expand Panel 1 Respirologist 1 Neurologist
ID & review guidelines
Flag important ordering practice variables
Changes in development
Decision support tools
• Smart forms
Education/promotion (physicians & patients)
• World Café
• Radiation exposure & cost of imaging awareness
Ordering practice feedback (individual physician)
Successes & learnings so far…
Recognition of importance of this work
Willingness to work collaboratively
Ease obtaining consensus with ‘Practice Parameters’
Challenges
Scheduling
‘Guidelines already exist - we don’t need to do more’
Culture change/perceptions takes time
I am most proud of…
Physician-led
Partnership with Shared Care Committee – Partners in Care (SI-PiC)
Special Acknowledgements
Kathy Ilott, Partners in Care (PiC), Shared Care
Dr. John Mathieson, Medical Director, Medical Imaging
Scott McCarten, Director Medical Imaging
Call to Action
What can you STOP doing that provides little
to no value?
Questions?
Jennifer Furtado
@jen_furtado
Kathy Ilott
