Choosing wisely in adult hospital medicine: Co-creation of new recommendations for improved healthcare value by clinicians and patient advocates

Authors

Hyung J. Cho, New York City Health and Hospitals, 50 Water Street, New York, NY, 10013, USA. harryjcho@gmail.com.
Danielle Smith, Molina Healthcare, Long Beach, CA, USA.
Anita Hart, University of Michigan, Ann Arbor, MI, USA.
Rupesh Prasad, Advocate Aurora HealthFollow
Suchita Shah Sata, Duke University Hospital, Durham, NC, USA.
Karen Clarke, Emory University Hospital, Atlanta, GA, USA.
Olugbenga Arole, Griffin Hospital, Derby, CT, USA.
John Beurlein, Ascension, St. Thomas Health, Nashville, TN, USA.
Marina George, MD Anderson Cancer Center, Houston, TX, USA.
Carlton Moore, UNC School of Medicine, Raleigh, NC, USA.
Anneliese M. Schleyer, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Kathleene Wooldridge, Vanderbilt University Medical Center, Nashville, TN, USA.
Talya Bordin Wosk, UC San Diego, San Diego, CA, USA.
Elham Yousef, Cleveland Clinic Medical Center, Cleveland, OH, USA.
Jenna Goldstein, Society of Hospital Medicine, Philadelphia, PA, USA.
April E. Fegley, Society of Hospital Medicine, Philadelphia, PA, USA.
Megan Malouk, Society of Hospital Medicine, Philadelphia, PA, USA.
Mona Krouss, Icahn School of Medicine, New York, NY, USA.

Recommended Citation

Cho HJ, Smith D, Hart A, et al. Choosing Wisely in Adult Hospital Medicine: Co-creation of New Recommendations for Improved Healthcare Value by Clinicians and Patient Advocates. J Gen Intern Med. 2022;37(10):2454-2461. doi:10.1007/s11606-021-07269-4

Abstract

Background: The American Board of Internal Medicine Foundation's Choosing Wisely campaign has resulted in a vast number of recommendations to reduce low-value care. Implementation of these recommendations, in conjunction with patient input, remains challenging.

Objective: To create updated Society of Hospital Medicine Adult Hospitalist Choosing Wisely recommendations that incorporate patient input from inception.

Design and participants: This was a multi-phase study conducted by the Society of Hospital Medicine's High Value Care Committee from July 2017 to January 2020 involving clinicians and patient advocates.

Approach: Phase 1 involved gathering low-value care recommendations from patients and clinicians across the USA. Recommendations were reviewed by the committee in phase 2. Phase 3 involved a modified Delphi scoring in which 7 committee members and 7 patient advocates voted on recommendations based on strength of evidence, potential for patient harm, and relevance to either hospital medicine or patients. A patient-friendly script was developed to allow advocates to better understand the clinical recommendations.

Key results: A total of 1265 recommendations were submitted by clinicians and patients. After accounting for similar suggestions, 283 recommendations were categorized. Recommendations with more than 10 mentions were advanced to phase 3, leaving 22 recommendations for the committee and patient advocates to vote upon. Utilizing a 1-5 Likert scale, the top combined recommendations were reducing use of opioids (4.57), improving sleep (4.52), minimizing overuse of oxygen (4.52), reducing CK-MB use (4.50), appropriate venous thromboembolism prophylaxis (4.43), and decreasing daily chest x-rays (4.43).

Conclusions: Specific voting categories, along with the use of patient-friendly language, allowed for the successful co-creation of recommendations.

Document Type

Article

PubMed ID

35668237