Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely

Kost, Amanda; Genao, Inginia; Lee, Jay W.; Smith, Stephen R.

doi:10.3122/jabfm.2015.05.140332

Cited by 34 publications

(27 citation statements)

References 6 publications

(3 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19 There may, however, be greater hope for the success of interventions at a practice level. Kost et al 20 recently reported their interventions in 3 primary care residency programs. They educated providers about Choosing Wisely clinical behaviors and formulated instruction about a "step wise approach to communicating to patients a plan of care based on the recommendations."…”

Section: Barriers To Guideline-concordant Carementioning

confidence: 99%

See 1 more Smart Citation

Physician Cost Consciousness and Use of Low-Value Clinical Services

Grover

Abraham

Chang

et al. 2016

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

Purpose: Choosing Wisely TM engaged medical specialties, creating "top 5 lists" of low-value services. We describe primary care physicians' (PCPs') self-reported use of these services and perceived barriers to guideline adherence. We quantify physician cost consciousness and determine associations with use.Methods: PCP attendees of a continuing medical education conference completed a survey. For each Family Medicine Choosing Wisely behavior, participants reported clinical adherence. Likert scale items assessed perceived barriers. Low-value service frequency was the dependent variable. A validated Cost Consciousness Scale created the predictor variable. We hypothesized that participants with greater cost consciousness would report less frequent use of low-value services.Results: Of 199 PCP attendees, 143 (72%) participated. Papanicolaou test after hysterectomy was performed least (0.2 mean services performed/10 patients). Provider knowledge of sinusitis treatment guidelines was greatest but provided most frequently (3.9 mean services performed/10 patients). Practice related barriers were perceived most frequently for adhering to sinusitis treatment guidelines. Attitudinal barriers were greatest for avoiding osteoporosis screening in low risk patients. Greater cost consciousness was associated with less use of low-value services (P ‫؍‬ .03), greater knowledge of guidelines (P ‫؍‬ .001), and fewer perceived attitudinal and practice behavior-related barriers (P < .001 for each). Greater knowledge of guidelines was not associated with less use of low-value services (P ‫؍‬ .58). Familiarity with Choosing Wisely was associated with both greater cost consciousness (P ‫؍‬ .004) and less use of low-value services (P ‫؍‬ .03).Conclusions: Greater PCP cost consciousness was associated with less use of low-value services. Interventions to decrease perceived barriers and increase cost consciousness, perhaps by increasing awareness of Choosing Wisely, may translate into improved performance.

show abstract

Section: Barriers To Guideline-concordant Carementioning

confidence: 99%

“…In particular, greater adherence to osteoporosis screening and sinusitis treatment recommendations were noted. 20 …”

Section: Barriers To Guideline-concordant Carementioning

confidence: 99%

Physician Cost Consciousness and Use of Low-Value Clinical Services

Grover

Abraham

Chang

et al. 2016

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

show abstract

“…[25][26][27][28] However, three population-level analyses of insurance claims show mixed results. 3,4,29 Experts have thus proposed using implementation science to improve uptake of CW recommendations. 2,3,7,8 Our study demonstrates the effectiveness of this approach.…”

Section: Discussionmentioning

confidence: 99%

Deimplementation of Routine Chest X‐rays in Adult Intensive Care Units

Trumbo

Iams

Limper

et al. 2019

Journal of Hospital Medicine

View full text Add to dashboard Cite

Despite increased awareness of Choosing Wisely (CW) ® recommendations to reduce low-value care, 1 there is limited published data about strategies to implement these guidelines or evidence that they have influenced ordering patterns or reduced healthcare spending. [2][3][4][5][6] Implementation science seeks to accelerate the translation of evidence-based interventions into clinical practice and the deimplementation of low-value care. [7][8][9] Based on established principles of implementation science, we used a prospective, nonrandomized study design to assess a CW intervention to reduce chest X-ray (CXR) ordering in adult intensive care units (ICUs). 10 In ICUs, CXR ordering strategies may be routine (daily) or on-demand (with clinical indication). The former strategy's principal advantage is the potential to detect life-threatening situations that may otherwise escape diagnosis. 11 Disadvantages include cost, radiation exposure, patient inconvenience, false-positive workups, and low diagnostic and therapeutic value. 12,13 On-demand strategies may safely reduce CXR ordering by 32% to 45%. [11][12][13][14][15][16][17] Based on this evidence, the Critical Care Societies Collaborative and the American College of Radiology have recommended on-demand CXR ordering. 18,19 Here, we describe the effectiveness of an intervention to reduce CXR ordering in two ICUs while evaluating the deimplementation strategies using a validated framework. METHODS Setting and DesignVanderbilt University Medical Center (VUMC) is an academic referral center in Nashville, Tennessee. The cardiovascular ICU (CVICU) has 27 beds and the medical ICU (MICU) has 34 beds. Acute care nurse practitioners (ACNPs) and two critical care physicians staff the CVICU; cardiology fellows, anesthesia critical

show abstract

“…1 They concluded that "primary care physicians respond to training and publicity in low-value care." This intervention strategy decreased physician-initiated testing that provide little clinical value.…”

Section: Re: Clinical Decisions Made In Primary Care Clinics Before Amentioning

confidence: 99%

Re: Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely

Gladwell

2016

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely

Cited by 34 publications

References 6 publications

Physician Cost Consciousness and Use of Low-Value Clinical Services

Physician Cost Consciousness and Use of Low-Value Clinical Services

Deimplementation of Routine Chest X‐rays in Adult Intensive Care Units

Re: Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely

Contact Info

Product

Resources

About