Today’s Managing Health Care Number is 2
It’s been a quiet week of holiday non-news – and I was happy that two important studies of educational interventions on providers and patients to increase value based medical care were published in December when they weren’t likely to be so widely read. I’ deeply believe in hte importance of educating clinicians and patients about what care is most likely to provide benefit – but these studies showed that getting patients to demand or doctors to deliver less low value care is not easy!
One group of researchers in JAMA Internal Medicine reported on a study which randomized 775 people who were considering whether to get low value screening procedures (prostate cancer screening in men, and mammography in young women and colonoscopy in older men and women) into four groups – each of which received a one page information sheet formatted differently. These were words, numbers, numbers and narrative, and numbers plus a framed presentation. Intentions to accept screening were high before the intervention – and the intervention didn’t change this. The researchers conclude:
Single, brief, written decision support interventions, such as the ones in this study, are unlikely to be sufficient to change intentions for screening. Alternate and additional interventions are needed to reduce overused screening services.
JAMA Internal Medicine also reported on whether members of Anthem Health Plan (the second largest in the country) had fewer of seven low value procedures or services since the Choosing Wisely program began. The abstract tries to paint a rosy picture – and emphasized modest declines in two of the seven services. However, overall, the results look grim. The declines were small, and two of the other low value services actually had increases.
A few thoughts about these two disappointing studies:
· Hats off to the researchers for publishing these results, even if they didn’t show the wild success they had hoped
· Hats off to JAMA IM as well. The ineffectiveness of a promising intervention is important information, and such information is often not disseminated.
· It’s WAY TOO early to write off Choosing Wisely and patient information on low value screening tests. I suspect that we need to get better at communicating this information – and we’ll need to try multiple different approaches simultaneously to determine the best approach, which might be different based on patient (or provider) segmentation
· We need to create social buzz around evidence based care. We need to have patients talk among themselves about how relieved they are to not undergo unnecessary pap smears or prostate biopsies, and physicians need to be proud to have a lower rate of use of inappropriate antibiotics or imaging.
We cannot afford to continue to deliver huge quantities of low value services. We’ll need to keep on experimenting with the combination of information, consumer price sensitivity, and provider payment reform to improve the value of care that we deliver.
