Continuing to Choose Wisely

For those who are regular readers, we have previously discussed the Choosing Wisely campaign from the ABIM Foundation and its goal to reduce unnecessary and potentially harmful testing. Some experts estimate 30% of health care spending is considered wasteful (i.e. no benefit provided to the patient).

In September the Washington Health Alliance published their first report looking at Choosing Wisely measures and adherence in their state. Some of their findings were rather interesting.

  • Variation exists – in some counties there is a two-fold difference for some measures
  • Overuse is still a common problem
  • Location, location, location – makes a difference in care
  • There are opportunities to reduce waste in every county
  • Some patients are getting unnecessary and potentially harmful tests
  • Regional variations are influenced by a few factors

The report does point out that while the Choosing Wisely recommendations are just that, the consensus is that lower rates of the tests/treatments is generally desirable.

They reported the two biggest areas for improvement:

  • 25% of patients statewide are receiving imaging for uncomplicated headaches and the high- and low-performing counties had a variation of 28%.
  • 37% of patients statewide are receiving antibiotics for sinus infections. (Studies show < 2% of sinus infections advance to bacterial infections.) This measure showed a 40% variation in usage, with rates between 21% and 61%! Interestingly Medicaid patients were less likely to receive antibiotics than commercially insured patients (28% vs. 43%).

There were two areas the counties were doing well on:

  • Unnecessary CT scans for sinus infections – < 1% of patients across the state received CT scans for this condition and there was not much variation across the counties (0 – 1.2%).
  • Only 4% of women under 21 were receiving Pap tests. Variation was only 10% as well.

Other recommendations measured were imaging for uncomplicated low back pain, imaging for simple syncope, CT scans for appendicitis, Pap tests with previous hysterectomy, too frequent Pap tests, follow-up testing for ovarian cysts, and spirometry testing for asthma.

Jeff Ribordy, MD

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