AMDA – The Society for Post-Acute and Long-Term Care Medicine Names 2019 Choosing Wisely® Champions
Two clinician teams have been named 2019 Choosing Wisely® Champions by AMDA – The Society for Post-Acute and Long-Term Care Medicine. The award honors individual clinicians and teams of clinicians who have gone above and beyond to make significant contributions to advance the ideals of the ABIM Foundation’s Choosing Wisely campaign by working to reduce unnecessary tests, treatments. and procedures in health care.
The first team, led by David Nace, MD, MPH, CMD, utilized AMDA’s Choosing Wisely recommendation #3: Don’t obtain a urine culture unless there are clear signs and symptoms that localize to the urinary tract. The second team—Peter Jaggard, MD, CMD; Rosina Finley, MD, CMD; Fatima A. Naqvi, MD, CMD; and Karl Steinberg, MD, CMD, MHDC—focused on AMDA’s recommendation #9: Don’t recommend aggressive or hospital-level care for a frail elder without a clear understanding of the individual’s goals of care and the possible benefits and burdens.
Dr. Nace and his team were awarded an Agency for Healthcare Research and Quality (AHRQ) grant to develop, test, and disseminate guidelines and tools for improving the diagnosis and treatment of uncomplicated cystitis in post-acute and long-term care (PALTC) settings. Through educating facility staff and providers and using quality improvement processes, the team pilot-tested the guidelines and tools in 26 nursing homes across the country. Facilities using these resources demonstrated a significant reduction in the inappropriate treatment of asymptomatic bacteriuria and in reported Clostridium difficile cases. Excessive duration of antibiotic treatment was also reduced. The project team is now disseminating the guidelines and tools to more nursing homes nationally. In addition to promoting the value of Choosing Wisely, this effort also helps nursing homes meet new Centers for Medicare & Medicaid Services (CMS) requirements on antibiotic stewardship and quality assurance and performance improvement (QAPI) programs.
“Sustainability is the ‘magic sauce’ in quality improvement,” Dr. Nace said, noting that in addition to developing and distributing the guidelines and tools, his team conducted one-on-one and group coaching calls, used a dashboard to highlight “all the things people were doing right,” and celebrated wins while learning from missteps. He said, “We are pleased to win this award. Having the Choosing Wisely list is collaborative but having this list and a research study is synergy. People are learning from our efforts. And, hopefully, it will move the needle [on antibiotic stewardship] a little.”
Dr. Jaggard and his team used the Society’s Advance Care Planning (ACP) Series to develop, promote, and document the content of discussions between patients/families and their physicians regarding goals, values, and preferences for medical treatment. They incorporated the materials in several facilities and trained practitioners on the use of these resources. The result was increased awareness and attention to person-centered care, palliative care, and end-of-life care, as well as improved transitions of care, pain management, patient/family satisfaction, and cost-effectiveness of care.
“While the goal for most post-acute residents is to rehabilitate function and return home, there is a subset of frail residents who need the opportunity to clarify and express their choices for shifting goals of care toward less aggressive care and more toward comfort care,” Dr. Jaggard said. “Offering ACP in these settings increases patient choice and implementation of their preferences for appropriate levels.”
Launched in 2012 by the ABIM Foundation, Choosing Wisely is widely recognized across the health care system as a leading effort to reduce overuse in medicine. More than 80 specialty societies, including AMDA, have joined the campaign and published over 600 recommendations regarding overused or unnecessary care.
For more information about Choosing Wisely and the Choosing Wisely Champions awards program, visit www.choosingwisely.org.
About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.
About ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. This is achieved by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org, connect on Facebook or follow on Twitter.
About Choosing Wisely®
First announced in December 2011, Choosing Wisely® is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at www.ChoosingWisely.org.