Are You and Your Doctor Choosing Wisely?

Statewide Campaign Encourages Clinician-Patient Conversations about Common Tests and Procedures

Are You and Your Doctor Choosing Wisely?

Massachusetts Health Quality PartnersBarbara Lambiaso, 617-600-4877

A collaborative of Massachusetts' patients groups, health care providers, payers, and state agencies today launched a month -long awareness campaign aimed at reducing the unwarranted use of diagnostic imaging in the treatment of lower back pain and persistent headaches. The local effort includes more than 20 organizations participating in and is being led by Massachusetts Health Quality Partners, a Choosing Wisely grantee of the ABIM Foundation.

“People suffering from lower back pain or frequent headaches want to know what's going on and they want relief,” said Steven Defossez, M.D., Vice President of Clinical Integration, Massachusetts Hospital Association (MHA), a practicing radiologist and MRI specialist. “Cross-sectional imaging tests are powerful tools, which when applied thoughtfully, can result in accurate diagnoses and appropriate care plan formation. Therefore it's not surprising that patients often look to an MRI or CT scan for answers. However, diagnostic imaging may not always be the best option. Over utilization of diagnostic imaging is wasteful at best and may actually be harmful. It's important for patients to work collaboratively with their caregivers, following evidence-based best practices, to get the best outcome.” (.*)

Dr. Paul Hattis, Massachusetts Health Policy Commissioner and public health professor at Tufts University Medical School, sees gaps in understanding that can be bridged by frank conversations. “Patients need to be given the opportunity to express their desires and concerns about testing or treatment options available to them, and providers need to be able to present the evidence and care options in a simple, understandable way,” he says. “It's not easy, but has excellent tools available on their website for any patient or doctor who wants to get the conversation started.”

By examining 2013 clinical quality data, Massachusetts Health Quality Partners (MHQP) found that about 20 percent of the imaging tests ordered for lower back pain by the state’s primary care physician practices are not indicated. Barbra Rabson, MHQP’s president and CEO, says, “We know from our years of reporting on quality measures that doctors’ offices vary widely in how they deliver this care, despite the evidence.”

Rabson says that participating organizations and agencies will be disseminating Choosing Wisely information to their constituents – providers, patients, and consumer groups – throughout the month to raise awareness and interest in the campaign.

The collective effort will include the distribution of educational materials developed by medical professional groups to physicians’ offices, health plan members and other consumers across the state, public policy discussions about Choosing Wisely, blog postings and other online communications from supporters, and an active social media campaign, all coordinated by MHQP. MHQP has been leading the Choosing Wisely Massachusetts Campaign for two years with support from the ABIM Foundation and Robert Wood Johnson Foundation.

Several participants summed up the importance of the campaign this way:

“One of the most important imperatives in medicine is to deliver the right care at the right time,” said “We support the Massachusetts campaign because it provides physicians and patients with good information that can be used in their discussions about the benefits and risks of many common procedures and tests.”

“Encouraging conversations between patients and providers so they can make wise decisions about when tests and treatments are helpful and when they are not, supports better, more affordable care for patients and families.” says

“Patients and their families want and need to have information like what is readily available from the Massachusetts campaign if they are to become better partners informed about care,” says

“This campaign expands on a very positive collaboration among health plans, physicians and their members/patients that promotes consumer engagement and a better understanding of how cost-efficient care is also quality care,” said

"One of the key lessons we impart to health care professionals, in training and in practice, is the importance of providing high-quality and cost-effective care to patients and populations," "For our educational activities in support of high-value care, it is a great benefit to be able to draw upon a resource like , with its endorsement by medical societies and its tools for shared decision-making between clinicians and patients."

*Here’s what the evidence tells us about treating lower back pain and persistent headaches:

recommends against diagnostic imaging for lower back pain within the first six weeks unless clearly indicated by other evidence-based factors. They point out that imaging of the lower spine before six weeks does not improve outcomes, but does increase costs and may do more harm than good.(

points out that most people who seek medical help for headaches have migraines or tension-type headaches. While they can be very painful, all that is usually needed for doctors to diagnose them is a careful medical history and a neurological exam. Adding a CT scan or MRI rarely shows why a headache occurs and it does nothing to ease the pain. A patient might need diagnostic imaging if his or her doctor cannot diagnose the headache based on the exam and medical history, or if the exam finds something that is not normal. (

Patients can start a conversation with their health care provider by asking these five questions developed by Consumer Reports, a partner in the Choosing Wisely campaign:

is a partnership of Massachusetts Health Quality Partners, the ABIM Foundation, , and . It is an extension of the nationally renowned , a program aimed at helping physicians and patients work together to ensure that an appropriate level of care is delivered at the right time and in the right setting. To do so, Choosing Wisely has compiled lists from various medical specialty societies of evidence-based recommendations to aid physician-patient conversations about what is necessary and appropriate care.

) is a non-profit, broad-based coalition established in 1995 that provides reliable information to help physicians improve the quality of care they provide their patients and help consumers take an active role in making informed decisions about their health care. MHQP’s mission is to drive measurable improvements in health care quality, patients’ experiences of care, and use of resources in Massachusetts through patient and public engagement and broad-based collaboration among health care stakeholders, including physicians, hospitals, health plans, purchasers, patient and public advocates, government agencies, and academics.

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