An Austin physician wants to use hard data to expand the use of Choosing Wisely® in all medical practices. J. Russell Hoverman, MD, a hematologist and medical oncologist, is one of many Texas doctors who view the Choosing Wisely initiative as an important basis for determining the use of medical tests and procedures.
The American Board of Internal Medicine Foundation instigated this doctor-led initiative to make patients and physicians aware of frequently ordered tests or treatments that may be unnecessary. TMA became an active Choosing Wisely member in 2013 to educate doctors about the initiative. A wide range of national medical specialty societies have created lists of the most salient recommendations to help doctors make wise decisions about using the most appropriate tests and treatments based on a patient's situation.
In an article published in the Journal of Oncology Practice, Dr. Hoverman presented his views on the need to develop metrics and to measure Choosing Wisely outcomes.
Though it can be difficult to quantify the explicit outcomes with Choosing Wisely, Dr. Hoverman said, "The individual recommendations and the program overall cry out for measurement of impact."
The American Society of Clinical Oncology (ASCO) and the American Society for Radiation Oncology have created recommendations deemed most helpful for oncology. Along with applying these recommendations in his practice, Dr. Hoverman focuses on the direct value of the initiative.
"A culture of evidence in our professional societies and a rejection of rationales and defenses represent a high bar toward which the campaign is successfully pushing," he said.
Dr. Hoverman is adamant about quantifying Choosing Wisely because he believes metrics are necessary when establishing what he calls an "evidence of benefit."
Though an established metrics system is conducive for measurement, Dr. Hoverman knows this system comes with certain challenges. He presents three points concerning the measurement of impact:
1. "Some of these recommendations are complex, and, therefore, discrete data elements are difficult to retrieve.
2. "There are concurrent secular trends that mirror the recommendations, such as disease, drug, or technology management programs. For example, 24 of the first 45 recommendations (and three of the first five ASCO recommendations) concern imaging.
3. "The scope of measurement, especially to reach an individual physician level and include all costs (false positives, imaging, laboratory services, hospital use), requires collaboration among numerous entities, including electronic health record platforms, billing software, providers, and payers, including the Centers for Medicare & Medicaid Services."
In regard to Choosing Wisely, Dr. Hoverman believes "its presence has been impactful."
"The next step for specialty societies is to translate these recommendations into classical process improvement activities to improve efficiency by validating feasible quality metrics," he said.
For more information about the Choosing Wisely initiative, visit the TMA website, www.texmed.org/choosingwisely.
Texas Medicine, Feb. 2015