“The goal is not measurement. The goal is participation.”
ing for prostate cancer screening in men with no symptoms of the disease when they are expected to live [fewer] than 10 years.” But Dr. Walters says there is still “extreme variation” in how and when PSAs are used among patients with a short life expectancy.
Physician leaders say the Choosing
Wisely guidelines were developed, in part, by each specialty to reflect those areas where there is variation in physi- cian practice and to help close the gaps. When it comes to putting Choosing Wisely into practice, physicians’ own specialty society recommendations are a good place to start.
When Baylor Scott & White adopted
and Board of Trustees. A $50,000 grant from ABIM allowed TMA and the TMA Foundation to promote Choosing Wisely to Texas physicians in collaboration with county medical societies, the Texas Os- teopathic Medical Association, and state medical specialty societies. The grant runs through March 31, 2015.
Putting Choosing Wisely into practice To help physicians understand and im- plement the program, TMA created a webpage (
www.texmed.org/choosing wisely) that contains a suite of Choosing Wisely tools and videos. Dr. Walters differentiated the pro-
gram from more formal federal and commercial quality measurement initia- tives in that it does not include built-in quality metrics and it does not carry any financial bonuses or punishments. That doesn’t mean doctors should not try to find gaps in care and track their prog- ress; it does mean Choosing Wisely is fairly simple to put into practice. “These are just things we should not
be doing,” he said. “The goal is not mea- surement. The goal is participation. And there is still a role for awareness and practice change. This is very much about patient safety.” Another “beauty” of the program, he says, is that the lists are evidence-based guidelines vetted and developed by phy- sicians. Individual specialty societies developed the recommendations using the most current evidence about man- agement and treatment options within their specialty. The lists run the gamut, but are generally described as “things whose necessity should be questioned and discussed” between physicians and patients and include indications or flags for when something may be appropriate. “If you have already embedded evi- dence-based guidelines into your daily routines, then you are already abiding by many of the principles of Choosing Wise- ly,” said Dr. Walters, a member of the Na- tional Quality Forum’s measures review committee. But wide variations in prac- tice among physicians in different com- munities suggests the campaign “still has very real gains it can achieve.” He pointed to
Ronald S. Walters, MD
Cliff Fullerton, MD 52 TEXAS MEDICINE January 2014 Susan M. Strate, MD
prostate-specific antigen (PSA) tests as an example. The Choosing Wisely guidelines from the American Society of Clinical Oncol- ogy say: “Don’t perform PSA test-
the program, rather than designing a separate educational track from scratch, Dr. Wesson and other physician leaders took advantage of the Choosing Wisely lists and materials. “We made that infor- mation directly available to our physi- cians and began by encouraging them to access the information that their own societies are providing to them.” Because most medical care these days
is delivered by a health care team, step two was getting other health care profes- sionals such as physician assistants and nurses educated on Choosing Wisely. “That’s where we are now in galvanizing all of the providers as to the importance of it and why we are doing it,” he added. Baylor Scott & White is now working on the third — and perhaps more chal- lenging — step: hardwiring the Choos- ing Wisely recommendations into phy- sicians’ daily routines by incorporating them into an electronic medical record (EMR) system. That means creating cer- tain prompts, for example, that explain the indications for a particular test and require physicians to enter a reason be- fore ordering it. Dr. Wesson acknowledges this phase of implementing Choosing Wisely could pose some obstacles for practices, and the campaign is working to devise the easiest and most practical way for physi- cians to incorporate it into daily practice. But the obstacles are not insurmount- able, he says. Most, if not all, EMRs should allow practices to add on func- tions like those he describes, though not without some expense. And while using
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