The Choosing Wisely® in North Carolina initiative – which aims to reduce health care waste by helping patients make smart and effective health care choices – has resulted in significant reductions in the unnecessary use of antibiotics, Pap tests and scans for osteoporosis.
"An estimated 30 percent of all U.S. medical spending is wasted on what studies have shown to be unnecessary and ineffective tests and treatment," said Don Bradley, M.D., board member of the North Carolina Healthcare Quality Alliance (NCHQA), which received a three-year grant to conduct the program. "By working to reduce waste, and promote the practice of evidenced-based medicine, our aim is to demonstrate that health care can be more effective and affordable to all North Carolinians." Bradley is also the project’s principal investigator.
Choosing Wisely in North Carolina is a team effort of NCHQA’s five partners. Partners Duke Health and Cornerstone Health Care implemented programs to reduce unnecessary tests and procedures. The N.C. Medical Society, Blue Cross Blue Shield of North Carolina and the State Health Plan for Teachers and State Employees all conducted complementary efforts to educate clinicians and consumers in N.C. about the problem of test and antibiotic overuse.
The specific goals of Choosing Wisely in North Carolina were to reduce by 20 percent the unnecessary use of antibiotics to treat viral bronchitis in adults, DEXA scans to measure bone density in women younger than 65 and men younger than 70, and annual Pap tests for women between the ages of 30 and 65. These are all examples of care that is not recommended under current medical guidelines.
The program’s target goals were based on medical evidence that Pap tests are not needed in women between 30 and 65 because cervical cancer is rare in this age group; that DEXA scans are not needed in most men under 70 and women under 65 because most people don’t have serious bone loss and that the tests can expose patients to unnecessary radiation and be a waste of money; and that because most cases of bronchitis are from a virus, antibiotics, which fight infections, will not be effective. Antibiotics can have serious side effects – even leading to emergency room visits – and inappropriate use can breed "superbugs" that are resistant to treatment.
At Duke, the initiative has thus far resulted in a 27 percent decrease in the use of antibiotics to treat adult viral bronchitis. Cornerstone, now an affiliate of Wake Forest Baptist Health, exceeded the target goal for antibiotic use last winter and continues to see decreases. It also reduced unnecessary DEXA scans for osteoporosis by 56 percent and achieved a 47 percent reduction in unnecessary Pap tests.
"We are delighted with the work of the Choosing Wisely team that led to these results," said Yates Lennon, M.D., M.M.M., chief quality officer at Cornerstone. "Following national guidelines about how and when to use certain tests and procedures saves money for patients and health care providers alike without sacrificing quality of care."
At Duke, the Choosing Wisely concept has been integrated into training programs so that reducing medical waste and practicing evidence-based medicine will be second nature to physicians of tomorrow.
"Reducing potentially unnecessary testing and antibiotic use is in the best interest of individual patients and of the health care system as a whole," said Devdutta Sangvai, M.D., M.B.A., associate chief medical officer at Duke University Health System. "This concept is so important we have started teaching it to our trainees."
Choosing Wisely is an initiative of the ABIM Foundation, with support from the Robert Wood Johnson Foundation. Educational materials for the program were developed by Consumer Reports. NCHQA was one of seven agencies nationwide to receive a three-year grant in May 2015 to conduct the program.
Choosing Wisely is based on medical evidence that shows that hundreds of tests and treatments are frequently unnecessary, duplicative or even harmful. The ABIM Foundation joined with more than 80 medical specialty societies to develop evidence-based lists of more than 500 tests and procedures that should be questioned.
The goal of Choosing Wisely is to promote conversations between clinicians and patients and to help patients choose care that is supported by evidence, isn’t duplicative of other tests or procedures already received, is free from harm and is truly necessary.
Throughout the three-year grant period, NCHQA members shared information about unnecessary tests and procedures with patients and providers through webinars, talks at local civic and medical organizations, newsletter articles, and posters and brochures displayed at primary and urgent care sites.
Blue Cross Blue Shield of North Carolina, with 3.8 million customers, the North Carolina State Health Plan for Teachers and State Employees, with more than 685,000 members and dependents, and the N.C. Medical Society, with 12,000 members, helped spread the Choosing Wisely message throughout the state.
Media Contacts:
NCHQA: Sandhya Gopal, JD, MPH, Sandhya Gopal, 919-473-6856; sgopal@nchqa.org
Cornerstone: Mary Beth Nelson, 336-870-1476; mnelson@wakehealth.edu
Duke: Dr. Devdutta Sangvai, MD,MBA, Associate Chief Medical Officer, 919-660-0650; devdutta.sangvai@duke.edu
About North Carolina Healthcare Quality Alliance
The alliance works to improve the delivery of health care in N.C. and the health of North Carolinians by bringing stakeholders together. Its board of directors is comprised of representatives from government, public-private partnerships, medical societies, insurers, hospital associations, academic medical centers, businesses and consumers.
