Choosing Wisely: An idea worth sustaining
Autor: | Kimberly Wintemute, Jennifer Zadravec, Leigh Hayden, Monika Kastner, David Eisen, Manuel Giraldo, Julie Makarski, Deepak Sharma, Kathryn Mossman, Marwan Asalya, Donna McRitchie, Phil Shin, Kegan Harris, Edith Rolko, Linda Jussaume |
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Rok vydání: | 2021 |
Předmět: |
Ontario
Hospitals and Health System Value and Quality Medical education Data collection Descriptive statistics business.industry 030503 health policy & services Health Policy education Qualitative property Focus group Hospitals 3. Good health 03 medical and health sciences 0302 clinical medicine Workflow 11. Sustainability Health care Humans Survey data collection 030212 general & internal medicine 0305 other medical science business Baseline (configuration management) Psychology |
Zdroj: | Health Serv Res |
ISSN: | 1475-6773 0017-9124 |
Popis: | OBJECTIVES: To evaluate the sustainability potential of Choosing Wisely (CW) to address unnecessary medical care at Ontario community hospitals. DATA SOURCES/STUDY SETTING: Ontario community hospitals and their affiliated family health teams (FHTs). STUDY DESIGN: A mixed‐methods study involving the administration of a validated sustainability survey to CW implementation teams followed by their participation in focus groups. DATA COLLECTION/EXTRACTION METHODS: Survey data were collected using an Excel file with an embedded, automated scoring system. We collated individual survey scores and generated aggregate team scores. We also performed descriptive statistics for quantitative data (frequencies, means). Qualitative data were triangulated with quantitative assessments to support data interpretations using the meta‐matrix method. PRINCIPAL FINDINGS: Fifteen CW implementation teams across four Ontario community hospitals and six affiliated primary care FHTs participated. CW priority areas investigated were de‐prescribing of proton pump inhibitors (PPIs) and reducing Pre‐Op testing and BUN/Urea lab testing. Survey results showed steady improvements in sustainability scores from baseline to final follow‐up among most implementation teams: 10% increase for PPI de‐prescribing (six FHTs) and 2% increase (three hospital teams); 18% increase in BUN/Urea lab testing (three hospital teams). Regardless of site or CW priority area, common facilitators were fit with existing processes and workflows, leadership support, and optimized team communication; common challenges were lack of awareness and buy‐in, leadership engagement or a champion, and lack of fit with existing workflow and culture. All teams identified at least one challenge for which they co‐designed and implemented a plan to maximize the sustainability potential of their CW initiative. CONCLUSIONS: Evaluating the sustainability potential of an innovation such as Choosing Wisely is critical to ensuring that they have the best potential for impact. Our work highlights that implementation teams can be empowered to influence implementation efforts and to realize positive outcomes for their health care services and patients. |
Databáze: | OpenAIRE |
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