An Idea Worth Sustaining: Evaluation of the sustainability potential of Choosing Wisely across Ontario Community Hospitals and Family Health Teams

Abstract

BackgroundEvidence shows that 30% of healthcare services are unnecessary and unlikely to benefit patients and may even be harmful. Choosing Wisely (CW) is a physician-initiated, international campaign (with campaigns in at least 20 countries) aimed at addressing unnecessary medical care through the provision of evidence-based resources and clinical guidance. Our objectives were to evaluate the sustainability potential of CW across four Ontario community hospitals and affiliated family health teams (FHT). MethodsWe recruited CW implementation teams across Ontario hospitals and their affiliated primary care family health teams (FHTs) to participate in a mixed-methods study to identify and respond to their CW implementation and sustainability challenges. The study involved the administration of a validated sustainability Survey at baseline, 6- and 12-months follow-up, and participation in two focus groups (at baseline and 6 months) to discuss identified successes and opportunities for improvement, and to respond to implementation and sustainability challenges through a team exercise involving the co-creation and implementation of an action plan to directly address them.ResultsFifteen CW implementation teams across five Ontario community hospitals and affiliated FHTs participated in the study. Three CW de-adoption priority areas were investigated by teams: de-prescribing of proton pump inhibitors (PPIs), and reducing Pre-Op testing and BUN/Urea lab testing. All 15 teams achieved a baseline sustainability team score that was well above the threshold of what is considered a potentially sustainable innovation (i.e., >55%). We observed steady improvements in sustainability scores over three time points across all primary care teams, which is a strong indication that CW is sustainable in these settings. Regardless of site or priority area, facilitators that were common across all teams were fit with existing processes and workflows, leadership support, and optimized team communication. Common challenges were: lack of awareness and buy-in, lack of leadership engagement or a champion, and lack of fit with existing workflow and culture. All teams identified at least one challenge (during the baseline focus groups) for which they co-designed and implemented a plan to address them aimed at maximizing the sustainability potential of their CW priority areas. ConclusionsEvaluating the sustainability potential of an innovation such as Choosing Wisely is critical to ensuring that they have the best potential for impact. Our work highlights that implementation teams can be empowered to influence their implementation efforts, and to realize positive outcomes for their healthcare services and patients.

Development of an Implementation Process Model: a Delphi study

“…By evaluating and refining the elements in the implementation process we have developed an evidence-based foundation to create a simple, user friendly tool that will be effective to support both implementation effectiveness and improved clinical outcomes. The findings of this Delphi study confirm the results of previous work [6,23] and underscore the importance of implementation support to facilitate effective, sustainable, improved outcomes for healthcare interventions.…”

Development of An Implementation Process Model: A Delphi Study

“…By validating the elements in the implementation process we have developed an evidence-based foundation to create a simple, user friendly tool that will be effective to support both implementation effectiveness and improved clinical outcomes. The ndings of this Delphi study con rm the results of previous work [6,23] and underscore the importance of implementation support to facilitate effective, sustainable, improved outcomes for healthcare interventions.…”

Using theories and frameworks to understand how to reduce low-value healthcare: a scoping review

“…This suggests to us that research specific to addressing Choosing Wisely recommendations is largely atheoretical at this point. Choosing Wisely campaigns are premised on the idea that the responsibility to reduce unnecessary practices is to be shared between physicians and patients with physicians as the stewards of healthcare resources, charged with ensuring that care is appropriate and sustainable [ 102 , 103 ]. This individual-level focus aligns with all of the studies included in this review and the type of theories used could benefit Choosing Wisely inspired efforts to reduce low-value care.…”