Choosing Wisely
The mission of Choosing Wisely is to promote conversations between clinicians and patients by helping patients choose care that is:
- Supported by evidence
- Not duplicative of other tests or procedures already received
- Free from harm
- Truly necessary
Beginning in 2012, national organizations representing medical specialists have asked their members to identify tests or procedures commonly used in their field whose necessity should be questioned and discussed. This call to action has resulted in specialty-specific lists of “Things Providers and Patients Should Question”. In addition, to help patients engage their health care provider in these conversations and empower them to ask questions about what tests and procedures are right for them, patient-friendly materials were created based on the specialty societies’ lists of recommendations of tests and treatments that may be unnecessary.
Choosing Wisely guidelines for clinicians have been developed by national medical specialty organizations and intended for adopted to support the goals above. WVPHI has uniquely partnered with medical specialty organizations in West Virginia to assess and identify Choosing Wisely guidelines of highest priority and undertake pilot projects that establish models that can be replicated across the state. Currently, WVPHI has two pilot projects, with additional under development. These include:
West Virginia Oral Health Coalition: Choosing Wisely delineates five oral health related recommendations. With support from WVPHI, the WCOHC is addressing two of the five recommendations focused on the early childhood population. The project focuses on the following two guidelines: 1) Don’t recommend non-fluoride toothpaste for infants and children, and 2) Sealant use in incipient occlusal caries should be considered in lieu of restorative intervention as a first line of treatment. This work will have a state-wide reach and will involve the West Virginia Dental Association Pediatric Section as a lead partner. Educational courses will feature Choosing Wisely guidelines, and how the guidelines are supported by evidence-based research, along with practical tips on how to implement guidelines. Over the course of the project, this work will serve to inform and shape the practice philosophies and protocols of both dental and medical providers.
West Virginia College of Emergency Physicians (WVCEP): Upon assessing all Choosing Wisely guidelines for emergency care, the WVCEP prioritized establishing a palliative care referral system network in West Virginia. With the aging population in West Virginia coupled with limited resources and the burden of chronic disease, early referral to hospice and palliative care services will result in an improved quality of life for our patients and better utilization of healthcare resources. In patients with a chronic or terminal illness (i.e. end-stage COPD), early referral provides comfort, relief of symptoms, and avoids prolonged futile care. Appropriate management and referral will enable inpatient hospital beds to be available for other diagnoses. Key to this initiative will be addressing other factors such as underlying social determinants of health (SDoH) that can change quickly and present new unmet needs for patients, causing them to seek urgent/emergency health care as a primary resource and frequently resulting in inpatient admission. When patients can be successfully engaged with new resources and care they will be less likely to seek care through emergency care services. When successful, patients, payers, and providers benefit. This pilot project will promote utilization of a multi-disciplinary team approach to provide early referral and implementation of palliative and hospice care services from the emergency department, including education of physicians in training and in practice. In addition, efforts will be undertaken to promote, at a systems level, the development of a West Virginia Palliative Referral System
Additional initiatives under development and will be added as initiatives are underway.