Monika Kastner1,2, Julie Makarski1, Kathryn Mossman1, Kegan Harris1, Leigh Hayden1, Manuel Giraldo3, Deepak Sharma4, Marwan Asalya4, Linda Jussaume5, David Eisen6, Kimberly Wintemute6, Edith Rolko7, Phil Shin8, Jennifer Zadravec9, Donna McRitchie5,10. 1. Knowledge Translation and Implementation, Centre for Research and Innovation, North York General Hospital, Toronto, Ontario, Canada. 2. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada. 3. Pathology and Core Labs, North York General Hospital, Toronto, Ontario, Canada. 4. Decision Support, Health Information Management, North York General Hospital, Toronto, Ontario, Canada. 5. Department of Surgery, North York General Hospital, Toronto, Ontario, Canada. 6. Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada. 7. Department of Pharmacy, North York General Hospital, Toronto, Ontario, Canada. 8. Department of Medicine, North York General Hospital, Toronto, Ontario, Canada. 9. Department of Medical Imaging, North York General Hospital, Toronto, Ontario, Canada. 10. Department of Medical and Academic Affairs, North York General Hospital, Toronto, Ontario, Canada.
Abstract
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.
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.
Authors: John P A Ioannidis; Sander Greenland; Mark A Hlatky; Muin J Khoury; Malcolm R Macleod; David Moher; Kenneth F Schulz; Robert Tibshirani Journal: Lancet Date: 2014-01-08 Impact factor: 79.321
Authors: Lisa A Cranley; Greta G Cummings; Joanne Profetto-McGrath; Ferenc Toth; Carole A Estabrooks Journal: BMJ Open Date: 2017-08-11 Impact factor: 2.692
Authors: Jeremy M Grimshaw; Andrea M Patey; Kyle R Kirkham; Amanda Hall; Shawn K Dowling; Nicolas Rodondi; Moriah Ellen; Tijn Kool; Simone A van Dulmen; Eve A Kerr; Stefanie Linklater; Wendy Levinson; R Sacha Bhatia Journal: BMJ Qual Saf Date: 2020-02-06 Impact factor: 7.035
Authors: Sarah F Schell; Douglas A Luke; Michael W Schooley; Michael B Elliott; Stephanie H Herbers; Nancy B Mueller; Alicia C Bunger Journal: Implement Sci Date: 2013-02-01 Impact factor: 7.327
Authors: Monika Kastner; Julie Makarski; Kathryn Mossman; Kegan Harris; Leigh Hayden; Manuel Giraldo; Deepak Sharma; Marwan Asalya; Linda Jussaume; David Eisen; Kimberly Wintemute; Edith Rolko; Phil Shin; Jennifer Zadravec; Donna McRitchie Journal: Health Serv Res Date: 2021-12-20 Impact factor: 3.734