Using patient-oriented evidence that matters (POEMs) to generate potential recommendations for the Choosing Wisely campaign

Kenneth Lin, MD, MPH

Kenneth Lin, MD, MPH

Background

The Choosing Wisely campaign is attempting to reduce low-value care worldwide by asking physician and other clinician groups to identify five or more commonly provided medical services that clinicians and patients should question because they are duplicative, unnecessary, and/or harms likely exceed benefits. Although nearly 80 medical societies have issued more than 500 recommendations since the U.S. campaign began in 2012 (1, 2), the process of developing recommendations has often lacked rigor, and many have not been derived from high quality, patient-oriented evidence (3).

Methods

POEMs are concise summaries of original research. They are delivered daily to clinicians worldwide in a popular literature surveillance service. Using the validated Information Assessment Method (IAM) questionnaire in the ongoing POEMs continuing medical education program, physician members of the Canadian Medical Association submitted an average of 1,382 completed questionnaires per POEM, on 265 unique POEMs delivered in 2016. From this set of POEMs, we identified those ranking highest on one item in the IAM questionnaire that is directly linked to reducing low-value care. Results A summary of the top low-value care POEMs appears annually in the journal American Family Physician (4). We identified physician comments on 9 POEMs that suggested barriers to implementation of these research findings in practice. These barriers may suggest an agenda for future research into drivers of, and interventions addressing, low-value care.

Results

A summary of the top low-value care POEMs appears annually in the journal American Family Physician (4). We identified physician comments on 9 POEMs that suggested barriers to implementation of these research findings in practice. These barriers may suggest an agenda for future research into drivers of, and interventions addressing, low-value care.

Discussion

Using a systematic, data-driven, and transparent strategy, we summarize the evidence presented in the top POEMs of 2016 consistent with the principles of the Choosing Wisely campaign. Recommendations based on these studies describe interventions whose benefits are not superior to other options, are sometimes more expensive, or put patients at increased risk of harm. Disseminating these POEMs to members and leaders of specialty societies involved in the Choosing Wisely campaign has the potential to help generate future recommendations.

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References

1. Kerr EA, Kullgren JT, Saini SD. Choosing Wisely: how to fulfill the promise in the next 5 years. Health Affairs 2017;36:2012-2018.

2. Siwek J, Lin KW. Choosing Wisely: more good clinical recommendations to improve health care quality and reduce harm. Am Fam Physician 2013;88:164-168.

3. Lin KW, Yancey JR. Evaluating the evidence for Choosing Wisely in primary care using the Strength of Recommendation Taxonomy (SORT). J Am Board Fam Med 2016;29:512-515.

4. Grad R, Ebell MH. Top POEMs of 2016 consistent with the principles of the Choosing Wisely campaign. Am Fam Physician 2017;96:234-239.