The Society for Post-Acute and Long-Term Care Medicine Names 2018 Choosing Wisely® Champion
Dheeraj Mahajan, MD, CMD, has been named a 2018 Choosing Wisely® Champion 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.
Launched in 2012 by the ABIM Foundation, Choosing Wisely is widely recognized across the health care system as a leading effort to reduce overuse and waste in medicine. More than 80 medical specialty societies, including AMDA, have joined the campaign and published over 550 recommendations regarding overused or unnecessary care.
“The Choosing Wisely campaign is critical, and we are pleased that our members are using this resource in their efforts to advance quality care,” says Society President Cari Levy, MD, PhD, CMD. “In an environment where we are faced with so much information, the Choosing Wisely lists help focus our attention on issues we agree are important to our patients. I often look at issues identified by other specialties and hope they do the same with ours.”
Dr. Mahajan’s initiative was designed to reduce the incidence of urinary tract infection (UTI) in nursing home patients transferred to emergency departments. “While urinary tract infections are monitored and tracked in long-term care facilities, little work has been done in emergency departments,” said Dr. Mahajan, President and CEO of Chicago Internal Medicine Practice and Research (CIMPAR).
Along with geriatrics fellows from Loyola University and Edward Hines Jr. VA Hospital, Dr. Mahajan analyzed emergency department transfers in the last year through retrospective chart reviews for patients from skilled nursing facilities sent out to the closest ED.
Of 20 patients transferred, 13 had urine analysis performed. Over 60 percent of patients who received the urine analysis had no clear indications for the test and those who were diagnosed with a UTI were all given antibiotics.
“With this information, we have initiated an education program geared toward emergency department providers to review the appropriate indications for ordering a urinalysis and culture. After the interventions, we found an immediate significant drop in the incidence of urinary tract infection diagnosis in patients returning from ED,” said Dr. Mahajan. The intervention and education occurred in late February 2018, and his team is planning to finalize three months of data to perform a formal statistical analysis. Having the Choosing Wisely recommendation on this issue—"Don’t obtain a urine culture unless there are clear signs and symptoms that localize to the urinary tract”—and the clinical evidence and support of experts behind it were significant, Dr. Mahajan said. “To have specialty societies such as AMDA backing up the data on this was very helpful and much more powerful than me just quoting an article from the literature.”
Dr. Mahajan was honored but surprised to receive the award. “I had stepped out of the room to say good morning to my children back home, so I missed the announcement. I started getting congratulatory messages and was pleasantly surprised.” He and his team, he said, are honored to be recognized and proud of what they were able to accomplish.
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.