The Choosing Wisely® campaign has attracted a lot of attention from the so-called “grasstops” in the form of physician leaders, policy makers, researchers, delivery system leaders, journal authors and the media. This top-down strategy was necessary given a political environment that invoked terms such as “rationing” and “death panels.” Yet, the “grasstops” strategy of the Choosing Wisely campaign has sparked conversations about wasteful tests and procedures among leaders and organizations and has helped legitimize such conversations—and more importantly, actions—among those who can put words into action; moving the campaign from grasstops to grassroots. Cardiologist and American College of Cardiology leader, Dr. Blair Erb, in his “Curbing Overuse” cover story in Modern Healthcare, said, “What Choosing Wisely has done is legitimize our ability to cut back on what’s unnecessary.”
With the aid of a generous grant from the Robert Wood Johnson Foundation (RWJF), the ABIM Foundation has in turn awarded 21 grants to specialty societies, state medical societies and regional health collaboratives. The aim of these grants is to bring Choosing Wisely down to the grassroots level – for physicians and patients to:
- learn about the recommendations from the specialty societies;
- have informed conversations; and,
- change attitudes of both physicians and patients that more is not always better.
Response to the request for proposals for the grants was overwhelming and demonstrated tremendous interest and belief in the principles behind the Choosing Wisely campaign. While we were unable to award grants to all, many who did not receive funding will be advancing those initiatives and participating in a learning network sponsored by RWJF and operated by ABIM Foundation.
Over the next two years, the grantees will use standard media channels, such as press releases, social media, webinars, newsletters, etc., to educate their members, the public and affiliated organizations on the campaign and the recommendations from specialty societies. Several programs will send out pre- and post-surveys to evaluate their efforts.
Several proposals included unique features such as:
- Pilot programs in major health systems to address the issue of overuse;
- Development of mobile applications;
- Linking improvement and measurement efforts to quality incentives;
- Awards for the best practice implementation of the recommendations in that specialty;
- Working with an EMR vendor to embed the recommendations into clinical decision-support tools; and,
- Development of an educational tool on resource use and appropriate care for practicing physicians and residents.
We hope these grantees will create more conversations at the grassroots level about the responsibilities of physicians and patients to think twice about the benefits and risks of a test or procedure, and facilitate attitudinal changes about more not always being better. We see these 21 grantees as beacons for the entire country about what can be done to change the quality, outcomes and affordability of American medicine.
