‘More Is Not Always Better’ for Medical Imaging

A5: The Goldilocks Principal: Providing Care That’s Just Right

Jennifer Furtado Consultant, Medical Quality Improvement Medical Affairs Island Health

Disclosure

I have no affiliations (financial or otherwise) with a commercial organization

A patient’s story

GP Orthopedic specialist

MRI CT

$ 330 $ 200

Wait time ~ 340 days Wait time ~ 155 days

Radiation = ~ 0.2 mSV (equivalent to ~ 200 X-rays)

No change in treatment/diagnosis

Perhaps….

‘More Is NOT Always Better’ in Healthcare

Appropriateness Acceptability

Accessibility

Safety

What are the risks associated with doing

the study or NOT doing the study?

What are other options?

How will the results influence treatment

options?

Physicians are saying…

Ordering physicians

48% physicians requested more support/tools to help make decisions about which services were appropriate for their patients (CMA survey, 2016)

Receiving orderings

“Not sure which test would be the best to

elucidate certain problems”

(GP, Divisions of FP)

“With some of the newer imaging I am not always aware of the best test to do”

(GP, Divisions of FP) “I see histories/reason for exam not appropriate for the exam ordered.” (Island

Health)

Why is this happening

In-appropriateness rates vary 2 - 13.6%

Consistent barriers reported

Lack of

Training or Experience Growth of medical imaging Access to guidelines Experience to specific patient group

and….

…Culture

Physicians’ Perceptions • Potential Litigation

• Comfort in affirming results

Patients’ Perceptions • Limited understanding of risk

factors • Need to ‘get something’

1/3 physicians self-report they acquiesce to patients’ request for tests even when they know they are not necessary (Professionalism in Medicine 2007 national survey)

The Choosing Wisely approach

AIM - To promote communication between

physicians (GP↔ SP↔ SP) AND their patients

Core competencies: ‘Professionalism in Action’

• Maintaining & supporting best practices

• Involving patients in shared decision-making

• Promoting responsible use of finite resources

Where we are at

Determine focus area

Develop ‘Flags’

Develop change ideas

Implement ideas

Evaluate

Established partnership with Shared Care Formation of an advisory panel 5 GPs 4 Radiologists 3 Emergency Medicine 3 Administration

Physicians ID area of improvement CT-PE & CTA

We are here

Expand Panel 1 Respirologist 1 Neurologist

ID & review guidelines

Flag important ordering practice variables

Changes in development

Decision support tools

• Smart forms

Education/promotion (physicians & patients)

• World Café

• Radiation exposure & cost of imaging awareness

Ordering practice feedback (individual physician)

Successes & learnings so far…

Recognition of importance of this work

Willingness to work collaboratively

Ease obtaining consensus with ‘Practice Parameters’

Challenges

Scheduling

‘Guidelines already exist - we don’t need to do more’

Culture change/perceptions takes time

I am most proud of…

Physician-led

Partnership with Shared Care Committee – Partners in Care (SI-PiC)

Special Acknowledgements

Kathy Ilott, Partners in Care (PiC), Shared Care

kathy.ilott@sidfp.com

Dr. John Mathieson, Medical Director, Medical Imaging

Scott McCarten, Director Medical Imaging

Call to Action

What can you STOP doing that provides little

to no value?

Questions?

Jennifer Furtado

Jennifer.Furtado@viha.ca

@jen_furtado

Kathy Ilott

kathy.ilott@sidfp.com