Choosing Wisely New Zealand Information Forum

Launched in 2012 in response to increasing evidence of over utilisation of health care in the US

What is Low Value care? Confers little or no benefit on patients Risk of harm exceeds likely benefit Costs do not provide proportional benefit Few interventions are never of benefit eg Low risk/high risk screening or timing of interventions. Value = Outcome/Cost

Factors that encourage over intervention Fee for Service healthcare Activity funded healthcare Concern over errors of ommision Patient perception that “more must be better” Misunderstanding of risks by clinicians and patients

1. Lists of Low Value Investigations and treatments Evidence based Developed by the Health Professional Org 2. Consumer/Community Engagement In partnership with Consumer Reports Patient centred care

Is there low value healthcare in NZ? Indirect measures (eg Atlas)of utilisation suggest yes. Limited direct data available but may in future to be available via registries and patient flow data Medicare data suggests 150 potentially low value practices in Australia and some of these also occur in NZ Commonwealth Fund Primary Care and Patient Data does suggest we may have less of a problem than other countries

Does Choosing Wisely duplicate existing programs ?

Choosing Wisely ? Health Professional lead Collaboration between Health Professionals and Patients/Community Shared Decision Making

Sharing Expertise Clinician Patient Diagnosis Aetiology Prognosis Treatment options Outcome probabilities Patient Experience of Illness Social circumstances Attitude to risk Goals, values, preferences Support needs

Risk Communication Explain Uncertainty Numbers better than words Natural frequencies rather than percentages Specific time frames Constant denominators rather than nominators Use both positive and negative framing Use simple graphics Individually tailored probabilities adjusted for baseline risk where possible

Types of Decision Support Clinical guidelines Assumes doctor makes decisions Evidence based Describes likelihood of outcomes Outlines uncertainties Recommendations based on values of clinical experts Patient Decision Aids Assumes shared decision making Evidence based Describes likelihood of outcomes Outlines uncertainties Does not make recommendations

Who should be involved? The Healthcare team Doctors, Nurses, Pharmacists, Dentists, Physio, Optometrists, Students Primary Care Hospitals and other Providers

Community awareness Point of Care Campaign Public Campaign Clinic Posters Clinic TV Information leaflets/cards Patient Decision Aids Public Campaign Print, Radio, Television Website, Facebook, Twitter etc

What have we done so far in NZ Steering committee with broad membership Engagement with stakeholders Partnership with Consumer NZ Initial work on CWNZ image/creative approach Initial contact with potential funders Binational Colleges well advanced Working with NZ only HP organisations

Evaluation 3 potential targets at Baseline and Change Provider Behaviour/utilisation Clinician attitudes and awareness Patients perceptions and outcomes

Better Conversations Information Deliberation Implementation Reliable Evidence based Outlines options, outcomes and uncertainties Deliberation Decision support ( personalised care planning ) Implementation Records , communicates and implemets patients wishes

What patients need to know What are my options What are the benefits and possible harms How likely are these benefits and harms How can you help me make a decision that’s right for me