The Choosing Wisely Project. Disclosures. Learning Objectives 3/18/2014. Marie Gilbert, PA C, DFAAPA

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1 The Choosing Wisely Project Marie Gilbert, PA C, DFAAPA Disclosures This speaker has no commercial relationships to disclose. Learning Objectives List the five "Choosing Wisely" program items for Otolaryngology. Explain the reasons for the recommendations to patients. *We will also discuss potential CME projects based on this program. 1

2 The American Academy of Otolaryngology Head and Neck Surgery Foundation List of Five Things Physicians and Patients Should Question (Released Feb 2013) What is Choosing Wisely? Choosing Wisely is an initiative of the American Board of Internal Medicine (ABIM) Foundation Aims to promote thoughtful conversations between physicians and their patients on the use of certain tests, procedures, and treatments to reduce unnecessary and potentially harmful diagnostic and therapeutic interventions. Each of the campaign s partners is asked to identify (initially) 5 items within its specialty that physicians and patients should question. According to the ABIM Foundation, each list provides specific, evidencebased recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Consumer Reports guidance for creating lists Societies were free to determine the process for creating their lists with the following requirements: Each item was within the specialty s purview and control Procedures should be used frequently and/or carry a significant cost Should be generally accepted evidence to support each recommendation Process should be thoroughly documented and publicly available upon request 2

3 Methodology for identifying the AAO HNSF list AAO HNSF Patient Safety and Quality Improvement (PSQI) Committee was charged by the AAO HNSF Board of Directors (BOD) with leading the list s development. Solicited input from: Members of the Specialty Society Advisory Council (SSAC) AAO HNS and AAO HNSF committees 20 distinct topics were identified represented the full spectrum of practice in otolaryngology narrowed by reviewing SSAC and committee support, supporting clinical evidence (such as AAO HNSF clinical practice guidelines), and the current use (frequency) of the test, procedure, or treatment. Choosing Wisely Partners Societies That Announced Lists April 2012 American Academy of Allergy Asthma & Immunology American Academy of Family Physicians American College of Cardiology American College of Physicians American College of Radiology American Gastroenterological Association American Society of Clinical Oncology American Society of Nephrology American Society of Nuclear Cardiology Societies That Announced Lists February 2013 American Academy of Family Physicians American Academy of Hospice and Palliative Medicine American Academy of Neurology American Academy of Ophthalmology American Academy of Otolaryngology Head and Neck Surgery American Academy of Pediatrics American College of Obstetricians and Gynecologists American College of Rheumatology American Geriatrics Society American Society for Clinical Pathology American Society of Echocardiography American Urological Association Society of Cardiovascular Computed Tomography Society of Hospital Medicine Society of Nuclear Medicine and Molecular Imaging Society of Thoracic Surgeons Society of Vascular Medicine Patient Education Consumer Reports is a partner in Choosing Wisely and will support the effort by creating patient-friendly materials based on the society recommendations and engaging a coalition of consumer communication partners to disseminate content and messages about appropriate use to the communities they serve. Available in English and Spanish Tools and resources can be found at: 3

4 Rosenfeld R M et al. Otolaryngology -- Head and Neck Surgery 2014;150:S1-S24 Copyright by American Academy of Otolaryngology- Head and Neck Surgery Consumer Response Findings from a December 2012 Consumer Reports survey of 2,669 consumers who received Choosing Wisely information: 72% agreed that it had changed their opinion of the topic, taught them new information, or prompted them to ask more questions of their health provider. 81% of consumers reporting interest in a Choosing Wisely topic said they were likely to have a conversation with their physician about what they had read. In the case of one topic (back pain), 85% intended to have a conversation with their doctor. Choosing Wisely is about stimulating conversations and we are well on our way. Source: John Santa MD, MPH, Director, Health Ratings Center, Consumer Reports presentation to AAO HNSF Guideline Task Force The AAO HNSF s List of Five Things Physicians and Patients Should Question: 6 recommendations were submitted to SSAC members for ranking, and the top 5 items were submitted to the BOD for approval. AAO-HNSF Lists: 1. Don t order computed tomography (CT) scan of the head/brain for sudden hearing loss. 2. Don t prescribe oral antibiotics for uncomplicated acute tympanostomy tube otorrhea. 3. Don t prescribe oral antibiotics for uncomplicated acute external otitis. 4. Don t routinely obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis. 5. Don t obtain computed tomography (CT) or magnetic resonance imaging (MRI) in patients with a primary complaint of hoarseness prior to examining the larynx. 4

5 Table 1. Elements of the diagnosis of diffuse acute otitis externa. Rosenfeld R M et al. Otolaryngology -- Head and Neck Surgery 2014;150:S1-S24 Copyright by American Academy of Otolaryngology- Head and Neck Surgery Computed tomography scanning is expensive, exposes the patient to radiation and offers no useful information that would improve initial management. CT scanning may be appropriate in patients with focal neurologic findings, a history of trauma or chronic ear disease 1. Oral antibiotics have significant adverse effects and do not provide adequate coverage of the bacteria that cause most episodes; in contrast, topically administered products do provide coverage for these organisms. Avoidance of oral antibiotics can reduce the spread of antibiotic resistance and the risk of opportunistic infections 2. 5

6 Oral antibiotics have significant adverse effects and do not provide adequate coverage of the bacteria that cause most episodes; in contrast, topically administered products do provide coverage for these organisms. Avoidance of oral antibiotics can reduce the spread of antibiotic resistance and the risk of opportunistic infections 3. Imaging of the paranasal sinuses, including plain film radiography, computed tomography (CT) and magnetic resonance imaging (MRI) is unnecessary in patients who meet the clinical diagnostic criteria for uncomplicated acute rhinosinusitis. Acute rhinosinusitis is defined as up to four weeks of purulent nasal drainage (anterior, posterior or both) accompanied by nasal obstruction, facial pain-pressure-fullness or both. Imaging is costly and exposes patients to radiation. Imaging may be appropriate in patients with a complication of acute rhinosinusitis, patients with comorbidities that predispose them to complications and patients in whom an alternative diagnosis is suspected 4. Examination of the larynx with mirror or fiberoptic scope is the primary method for evaluating patients with hoarseness. Imaging is unnecessary in most patients and is both costly and has potential for radiation exposure. After laryngoscopy, evidence supports the use of imaging to further evaluate 1) vocal fold paralysis, or 2) a mass or lesion of the larynx 5. 6

7 We know this will improve patient care. We know this will save the country billions. Can this help PAs too? New NCCPA Recertification Rules Practice Improvement Projects for CME: need 20 hours per two-year cycle, 4 out of 5 cycles on 10-year system. Choosing Wisely projects may fill that need stay tuned 7