Society’s Choosing Wisely Champions Take Lead on Sustainable Change

July 9, 2019
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“Sustainability is the ‘magic sauce’ in quality improvement,” said David Nace, MD, MPH, CMD, head of one of two clinician teams named as the Society’s 2019 Choosing Wisely® Champions. Dr. Nace utilized 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 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.

These awards honor 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.

Dr. Nace and his team developed 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. While 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.

In addition to developing and distributing the guidelines and tools, Dr. Nace and 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. 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 introduced the materials in several facilities and trained practitioners on their use. 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 and waste in medicine. More than 80 medical specialty societies, including the Society, have joined the campaign and published more than 600 recommendations regarding tests and treatments they say are overused or unnecessary. For more information about Choosing Wisely and the Choosing Wisely Champions awards program, click here.