Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs

Abstract

We describe a program called "Caring Wisely"®, developed by the University of California, San Francisco's (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely® program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff-aided by experienced implementation scientists-to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services. Financial savings of the program are intended to cover the program costs. The theoretical underpinnings for the design of the Caring Wisely® program emphasize the importance of stakeholder engagement, behavior change theory, market (target audience) segmentation, and process measurement and feedback. The Caring Wisely® program provides an institutional model for using crowdsourcing to identify "hot spot" areas of low-value care, inefficiency and waste, and for implementing robust interventions to address these areas.

Assessment of a Simulated Case-Based Measurement of Physician Diagnostic Performance

“…New technological breakthroughs in machine learning, while largely touted for their applications to patient care, are now beginning to be used in medical education. 24,25,26 There is real value in harnessing the experience or collective wisdom of the medical community for benchmarking and mimicking real-world practice where differentials are generated without an offering of multiple choice. Rather than selecting from a predefined list of options, these free-texted differentials are interpreted and scored by a system that uses prefixed search, autocomplete, and natural language processing to structure the data.…”

Establishing a Data-Sharing Environment for a 21st-Century Academic Health Center

“…An example of collaboration with our clinical partner institution was a project originating from a resident physician along with the Dell Medical School value-based health team 35 for grant-funded graduate medical education quality improvement projects to identify and reduce unnecessary laboratory tests ordered in the emergency department for patients with possible acute coronary syndrome. The Data Core identified an order set being invoked by physicians that included unnecessary tests resulting in avoidable costs.…”

Emerging principles for health system value improvement programmes

“…The report of the NYU programme joins the value-driven outcomes programme from the University of Utah as one of the most well-described, and rigorously evaluated, systematic transformations aimed at value improvement in hospitals in the USA 15 16. These programmes are structured similarly to smaller scale models we helped develop at the University of California at San Francisco (UCSF),13 14 as well as a faculty-resident project-based programme at the University of Vermont 18. We consider this branch of value improvement a closely related but different species from the Lean-based healthcare programmes pioneered by Virginia Mason and the development of care pathways prominently described by Intermountain Healthcare, both of which have also yielded improved outcomes and decreased costs 19…”

“…In concert with the launch of the ‘Choosing Wisely’ campaign in the USA in 2012, hospitalists led projects that largely sought to root out individual areas of overuse and ‘things we do for no reason’, ushering in a renewed emphasis on utilisation in hospitals 12 13. Now, we have begun to see results from health systems that have created organisational value improvement programmes for hospitalised patients to simultaneously address both utilisation and costs, while measuring markers of quality and ensuring favourable patient outcomes 14–16…”