Wendy Levinson, MD Professor of Medicine, University of Toronto Chair, Choosing Wisely Canada Welch Public Health Conference 2014 October 7, 2014

Total health expenditures as percentage of gross domestic product (1970-2011)

Berwick D. JAMA. 2012.

Better to do something than nothing The patient wants it I’ve always done this New tests are good $$ I don’t want to get sued Better to do something than nothing Please make the first one come in at 1 oclock and then clockwise. This is how all of them work—please ask karen and see others-Done Referring doctor wants it

Choosing Wisely Canada (CWC) is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care.

History of the campaign Choosing Wisely® campaign began in 2012 in US; 70 medical societies are participating Choosing Wisely Canada launched in April 2014 More than 30 national specialty societies engaged and at various stages of recommendation development Choosing Wisely® efforts are also present in countries like Australia, Denmark, England, Germany, Italy, Japan, Netherlands, New Zealand, Switzerland, Wales Change title to History of the campaign

Campaign Approach Physicians Patients Media Stakeholders Societies develop lists Disseminate through multiple channels Physicians Develop patient materials Disseminate broadly through multiple channels Patients Coordinated approach toward media Multiple voices, a common message Media Work through health care stakeholder organizations to implement and support adoption Stakeholders

Putting recommendations into practice Make a new slide for this. I want a visual of putting the recommendations into practice and not a list of the groups. Maybe look at visuals for knowledge translation or something; move cedar sinai slide after this new one. Also I would like a new slide just ahead of this one to illustrate false positive results.

Cedars-Sinai Blind Spot Monitor: CW Embedded in CPOE

Better to do something than nothing The patient wants it How we are taught New tests are good Preemptive ordering Better to do something than nothing Lack of feedback Demonstrate thoroughness

Choosing Wisely Australia Choosing Wisely Canada Doing more does not mean doing better (Italy) Choosing Wisely Japan Choosing Wisely – The Netherlands Smarter Medicine (Switzerland) Choosing Wisely (U.S.) Prudent Healthcare (Wales)

Principles of a Choosing Wisely Campaign Physician led Patient-focused Evidence-based Multi-professional Transparent

Reduce unnecessary care, harm and waste Health care systems Clinical practice Physicians & patients Reduce unnecessary care, harm and waste Partnerships + Integration Shared Decision Making + Implementation Awareness + Education + Engagement