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Lee Fairclough and Dr. Wendy Levinson

Choosing Wisely for Better Care

Health care quality is defined as a health system that is safe, effective, patient-centred, timely, efficient, and equitable and the Choosing Wisely Canada campaign aligns with these goals.

Delivering high-quality care is about more than just appropriately providing care to those who require it in an equitable and safe fashion. It is also about not providing treatments, procedures or tests that are deemed to be unnecessary, or potentially harmful to patients.

This second part of the quality care formula is the impetus and driving force behind Choosing Wisely campaigns.

Started in the U.S. in 2012 and quickly adopted in Canada, Choosing Wisely Canada is a campaign to help clinicians and patients engage in conversations about unnecessary tests and treatments, and make smart choices to ensure high quality care.

Choosing Wisely Canada is led by health care professionals, with more than 50 national colleges, societies and associations, including Health Quality Ontario, participating as partners of the campaign.

The need for such an approach is documented in a recently released report, Unnecessary Care in Canada, by the Canadian Institute of Health Information (CIHI) and Choosing Wisely Canada. The report uses data to show the extent of unnecessary care across Canada associated with eight campaign recommendations.

Complementing this report, Health Quality Ontario has now documented why this campaign is important in Ontario and shared the steps clinical leaders and teams have taken to address the type of issues identified by Choosing Wisely Canada and CIHI. This information is contained in the report "Spotlight on Leaders of Change: Implementing Choosing Wisely Canada recommendations in Ontario to Improve Quality of Care".

The report shows how sound clinical data is being used to support implementation efforts to reduce unnecessary care in Ontario.

It also profiles how clinicians on the ground from primary care, hospital and long-term care are embedding Choosing Wisely Canada-related projects into organization-led quality projects and/or how larger efforts align with Health Quality Ontario’s broader work on quality.

The national report specifically notes three areas where Ontario could be doing better to reduce incidents of unnecessary care:

  • Almost 1 in 3 low-risk patients with minor head trauma had a head scan in an Ontario emergency department, despite a Choosing Wisely Canada recommendation that this is unnecessary and potentially harmful.
  • 35% percent of Ontario patients undergoing low-risk surgery had a preoperative test, such as a chest X-ray, ECG or cardiac stress test compared to 22% for patients in Saskatchewan and 18% in Alberta. Choosing Wisely Canada recommendations have identified pre-operative tests for low risk surgical procedures as being unnecessary and potentially harmful. The Health Quality Ontario report notes that there is almost a 30-fold variation in ordering practices of pre-operative tests between different hospitals in the province.
  • 1 in 10 seniors across Canada use a benzodiazepine on a regular basis to treat insomnia, agitation or delirium, yet a number of Choosing Wisely Canada recommendations highlight the harms of long-term use of these medications. Efforts have been underway for some time in Ontario to address this issue.

Clinicians in Ontario are already responding to these and other examples of unnecessary care. For example, at Mount Sinai Hospital in Toronto, the monthly proportion of in-patients being newly prescribed sedative hypnotic–drugs for sleep in the medicine and cardiology units has been reduced by more than 40% in one year. And the North York Family Health Team has reduced or eliminated unnecessary use of proton pump inhibitors among 60% of patients engaged over an 18-month period.

Implementation efforts associated with Choosing Wisely Canada have the potential to significantly advance the provincial quality agenda. Avoiding unnecessary care, reducing harm and not wasting system resources are ideas that providers, patients and organizations across the health care system can support. As with all improvement efforts though, it will take time and effort to make these changes.

Health Quality Ontario is an enthusiastic partner of the Choosing Wisely Canada campaign. In the coming months, working with provincial partner organizations and patients, we will establish a steering group to guide the formation of a regional Ontario Choosing Wisely campaign affiliate.

In addition to advancing specific Choosing Wisely Canada initiatives, this work will connect with other provincial quality improvement efforts at the grass roots level to improve care throughout the province.

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