TELUS Health Conference Toronto

Transcription

1 TELUS Health Conference Toronto Dr. Wendy Levinson, MD, OC Chair, Choosing Wisely Canada & International Professor of Medicine, University of Toronto March 23rd, 2016

2 Wedges of Waste 2

3 I ve always done this The patient wants it $$ New tests are good I don t want to get sued Better to do something than do nothing Referring doctor wants it 3

4 Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments and make smart and effective choices to ensure high-quality care. 4

5 Facts Choosing Wisely campaign began in 2012 in US; 70 medical societies are participating Choosing Wisely Canada launched in April 2014 More than 51 national specialty societies engaged; 170+ recommendations released 17 countries around the world are adapting the campaign and implementing it 5

6 What is unique about CWC? Clinician led Bottom up approach Focused on common clinical conditions Both primary care and specialties Simple Remarkably rapid uptake 6

7 Campaign Approach Physicians Societies develop lists Disseminate through multiple channels Patients Develop patient materials Disseminate broadly through multiple channels Media Coordinated approach toward media Multiple voices, a common message Stakeholders Work through health care stakeholder organizations to implement and support adoption 7

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9 Recommendations by category (n = 165) MEDICATION 15% Tests: 53% IMAGING 20% Treatments: 43% Procedures 4% 9

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11 The implementation spectrum ENGAGEMENT AND EDUCATION Leadership engagement Physician education Patient education QUALITY IMPROVEMENT QI projects Measurement Audit and feedback HARD CODING Policy changes EMR/CPOE integration Order set changes 11

12 North York General Hospital, Toronto Results so far: ED Lab Testing: 40% Pre-Op Clinic Lab Testing: 40% Inpatient Lab Testing: 5% Inpatient CT Exams: 5% ICU Chest X-Rays: 20% 12

13 Sunnybrook Health Sciences Centre, Toronto Results: Urinary catheter use on medical wards: 50%; no negative impact 13

14 Sunnybrook Health Sciences Centre, Toronto Results: Monthly RBC usage 29% Nova Scotia Provincial Health Authority Results: RBC Transfusion 16.4% 14

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16 Toronto Western Hospital Results: Patients prescribed PPIs 26% 93% of patients had their PPIs reassessed 16

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22 Measurement framework Provider Attitudes & Awareness Provider Behaviours: overuse of low value services Patient perceptions & outcomes 22

23 Preoperative testing 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Electrocardiograms Transthoracic Echocardiograms Stress Tests Chest X-rays Ontario Alberta Alberta preoperative testing prior to elective surgery in fiscal years 2005/ /07 Thanh et al. (2010) Ontario preoperative testing prior to elective low risk surgical procedures in fiscal years 2008/ /12 Kirkham et al. (2015) 23

24 rtion of procedures Proportion of Procedures Preoperative testing in Ontario: ECGs Preoperative Testing in Ontario 100% ECGs 7% 90% 80% 70% 60% 50% 40% 30% 20% 10% 6% 5% 4% 3% Average 2% testing across all institutions 1% 0% 0% 24 7% Stress tests 60%

25 Reduction of Inappropriate Benzodiazepine (BZD) Prescriptions through patient education 62% of group initiated conversation about BZDs with an MD/Pharmacist 27% of the group had discontinued BZDs Dose reduction occurred in additional 11% Tannenbaum, C et al. JAMA Intern Med. 2014; 174(6)

26 Current Measurement Work (CIHI) Anti-psychotics for insomnia (BC, SK, MB) Screening mammography in women (Pan-Canadian) Imaging for low-back pain: X-Ray &CT/MRI (AB, ON) Head CT for delirium (ON) Benzodiazepines in the elderly 26

27 Working with Provinces PTMAs Health regions QI organizations Measurement organizations 27 27

28 Where is Choosing Wisely Going? 28

29 Questions & Comments 29