Jerry Osheroff first articulated the 5 rights of decision support:
the right information
to the right people
in the right intervention formats
through the right channels
at the right points in workflow
Two talks I attended this week got me thinking about the right format and the right channels--what are the best ways to present information to clinicians to influence decisions and behavior?
Adam Elshaug spoke to the LHS Academy fellows about measuring low-value healthcare. He and his team led a consensus process to use diagnosis and procedure codes to create operational definitions for 27 measurable recommendations. They are now able to visualize variation across hospitals and individual clinicians to better track and influence low-value care. We discussed different ways you might use dashboards like these to decrease low-value care and. Of course, we also discussed the need for patients and GPs making referrals to have access to this information and the variety of concerns that arise when you start talking about using imperfect data to publicly display clinician performance.
Variation in use of selected low-value procedures in New South Wales (NSW) hospitals. Each point represents one hospital performing the relevant procedure. The red bars indicate the state average proportion, and grey points are consistent with the state average. Orange points are above and blue points below 99% control limits around the state rate. For definitions of low-value care, see online supplementary table 1. ERCP, endoscopic retrograde cholangiopancreatography; EVAR, endovascular repair of abdominal aortic aneurysm; PCI, percutaneous coronary intervention.
A big part of my research career was dedicated to using NLP to create more accurate digital phenotypes for research. In one study, we identified used NLP to measure whether the US Choosing Wisely campaign had been effective in decreasing carotid imaging for low-value indications like screening or syncope. Here are the conclusions of the study:
Choosing Wisely recommendations were not associated with a meaningful change in low-value carotid imaging in a national integrated health system. To reduce low-value testing and utilization cascades, interventions targeting ordering clinicians are needed to augment the impact of public awareness campaigns.
Simon D’Alfonso and Simone Schmidt presented our seminar on using a patient’s digital phenotype from their phone and social media use to enhance mental health visits. Imagine being able to look at changes in your travel habits, in your use of emojis, and in the way you are typing to provide insight to you to potentially share with your mental health clinician about your mood and functioning. I think of the 5 rights in framing how and when to present the data, and I loved the framework they presented for thinking about the ethical implications and the value it needs to bring to the clinical encounter.
This weekend, I drove to Canberra with my visiting daughter Clare and my son, and at a service area off the Hume Freeway, I decided to park the van before paying for gas. But after using the restrooms, as we call them, and ordering food, I forgot to go pay. Luckily, a BP staff member followed me to my van and reminded me! We have paid at the pump for almost as long as I’ve been an adult, so old habits die hard.
Regional Linguistic Quirks (RLQ): When I’m “thinking slow”, I remember to use Australian terms rather than American, but when I’m acting instinctively, I revert to 54 years of habit. I got called out on two phrases during my Canberra drive. The petrol station operator told me they don’t sell gas, when I said “I think I’ll purchase some gas and come back in for these sodas.” And the KFC worker told me they don’t sell chicken sandwiches even though I could see them on the menu above her. She explained that they were chicken burgers, and sandwiches were made with regular, dry bread. In the US “burgers” only means “hamburger”.
Canberra was below freezing, I saw my first bandicoot in the wild, and Clare got some good pictures.
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