Maughan Brandon C, Baren Jill M, Shea Judy A, Merchant Raina M
Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
Acad Emerg Med. 2015 Dec;22(12):1506-10. doi: 10.1111/acem.12821. Epub 2015 Nov 14.
The Choosing Wisely campaign was launched in 2011 to promote stewardship of medical resources by encouraging patients and physicians to speak with each other regarding the appropriateness of common tests and procedures. Medical societies including the American College of Emergency Physicians (ACEP) have developed lists of potentially low-value practices for their members to address with patients. No research has described the awareness or attitudes of emergency physicians (EPs) regarding the Choosing Wisely campaign. The study objective was to assess these beliefs among leaders of academic departments of emergency medicine (EM).
This was a Web-based survey of emergency department (ED) chairs and division chiefs at institutions with allopathic EM residency programs. The survey examined awareness of Choosing Wisely, anticipated effects of the program, and discussions of Choosing Wisely with patients and professional colleagues. Participants also identified factors they associated with the use of potentially low-value services in the ED. Questions and answer scales were refined using iterative pilot testing with EPs and health services researchers.
Seventy-eight percent (105/134) of invited participants responded to the survey. Eighty percent of respondents were aware of Choosing Wisely. A majority of participants anticipate the program will decrease costs of care (72% of respondents) and use of ED diagnostic imaging (69%) but will have no effect on EP salaries (94%) or medical-legal risks (65%). Only 45% of chairs have ever addressed Choosing Wisely with patients, in contrast to 88 and 82% who have discussed it with faculty and residents, respectively. Consultant-requested tests were identified by 97% of residents as a potential contributor to low-value services in the ED.
A substantial majority of academic EM leaders in our study were aware of Choosing Wisely, but only slightly more than half could recall any ACEP recommendations for the program. Respondents familiar with Choosing Wisely anticipated generally positive effects, but chairs reported only infrequently discussing Choosing Wisely with patients. Future research should identify potentially low-value tests requested by consultants and objectively measure the utility and cost of these tests among ED patient populations.
“明智选择”运动于2011年发起，旨在通过鼓励患者和医生就常见检查和程序的适当性相互交流，促进医疗资源的合理管理。包括美国急诊医师学会（ACEP）在内的医学协会已为其成员制定了潜在低价值医疗行为清单，以便与患者沟通。尚无研究描述急诊医师（EP）对“明智选择”运动的认知或态度。本研究的目的是评估急诊医学（EM）学术部门负责人对这些理念的看法。
这是一项针对设有全opathic EM住院医师培训项目机构的急诊科主任和科室主任的网络调查。该调查考察了对“明智选择”的认知、该项目的预期效果，以及与患者和专业同事就“明智选择”进行的讨论。参与者还确定了他们认为与急诊科使用潜在低价值服务相关的因素。问题和答案量表通过与急诊医师和卫生服务研究人员进行反复预试验进行了完善。
78%（105/134）的受邀参与者回复了调查。80%的受访者知晓“明智选择”。大多数参与者预计该项目将降低医疗成本（72%的受访者）和减少急诊科诊断性影像学检查的使用（69%），但对急诊医师的薪资（94%）或医疗法律风险（65%）没有影响。只有45%的主任曾与患者讨论过“明智选择”，相比之下，分别有88%和82%的主任与教职员工和住院医师讨论过此事。97%的住院医师认为会诊医生要求的检查是急诊科低价值服务的一个潜在因素。
在我们的研究中，绝大多数急诊医学学术带头人知晓“明智选择”，但只有略多于一半的人能回忆起美国急诊医师学会对该项目的任何建议。熟悉“明智选择”的受访者预计总体上会有积极效果，但主任们报告称很少与患者讨论“明智选择”。未来的研究应确定会诊医生要求的潜在低价值检查，并客观衡量这些检查在急诊科患者群体中的效用和成本。
