John Santa MD MPH Medical Director Consumer Reports Health January 24, 2014 Making Evidence Work For Consumers Presentation and Dissemination

Disclosures General internist, most recent practice at the VA in Employed by Consumers Reports: –Independent of industry, non profit, non partisan, consumer advocacy organization. –Multimedia company, publisher of Consumer Reports, ConsumerReports.org 20 million readers a month, older, affluent, well educated, “savvy buyers” Focused for 77 years on providing an alternative perspective to advertising and promotion Business models

NOWSOMEDAY?? HEALTH CARE ADVERTISING

Examples Comparisons of screening tests –Heart/vascular screening tests –Cancer screening tests Choosing Wisely Maternity

Consumer Reports Heart Disease Survey

Heart/Vascular Prevention Test Ratings Men, 45-54, Asymptomatic

Cancer Screening Tests Evidence applies to screening in average risk people Tests to do: –Cervical cancer –Breast cancer –Colorectal cancer Tests not to do: –Ovary, skin, bladder, testes, oral, lung, bladder, prostate

Communicating “What Not to Do” –Go where people are (Wikipedia & Vogue) –Talk about what they are talking about (usually benefits) and connect your dots to theirs (risk, waste) –Use safety if you can –Use empathic stories –Provide structure for decision making (consumers wary of not following doctor advice)

A successful communication campaign –Focused on professionalism Stimulating culture change –More is not better Create conversations about overuse –Communicating what not to do

Consumer Reports Consumer Reports is a partner in Choosing Wisely and will support the effort by creating patient-friendly materials based on the society recommendations and engaging a coalition of consumer communication partners to disseminate content and messages about appropriate use to the communities they serve. Tools and resources can be found at:

5 Questions to Ask Your Doctor Do I really need this? What are the downsides? Are there simpler, safer options? What happens if I do nothing? How much does it cost?

Choosing Wisely 2 page consumer oriented summary available on these topics December 2012 survey of 2669 consumers who had received Consumer Reports Choosing Wisely information 72 percent agreed that it had changed their opinion of the topic, taught them new information, or prompted them to ask more questions of their health provider. Eighty-one percent of consumers reporting interest in a Choosing Wisely topic said they were likely to have a conversation with their physician about what they had read.

Elective Delivery before 39 weeks Mother and practitioner agree to deliver baby prior to term –Multiple indications for this…but then not elective –Convenience Trends – : Full term birth decreased 26%; birth at 37/38 weeks increased 45% –2011 Leapfrog hospital-level data shows some improvement

Inducing labor without a medical reason Artificially induced labor doubled from 1990 to 2008 in the U.S. When indications for induction not present C-section 67% more likely Other interventions more likely –Epidural –Forceps/vacuum delivery Baby 64% more likely to end up in NICU

C-sections 33% of all deliveries are C-section….major surgery –More complications for mother and baby Key is urging vaginal delivery at first delivery Look for a doctor/hospital with C-section rate below 24% (ideally lower – 15%) Ask physician about their rate

Other issues Automatic second C-section Ultrasound after 24 weeks Continuous electronic fetal monitoring Early epidural Routine rupture of amniotic membranes Routine episiotomies Newborn to nursery

“When you’re through learning, you’re through.” John Wooden Former UCLA basketball coach

John Santa MD MPH Consumer Reports Health Medical Director