1. Choosing Wisely New Zealand
Information Forum

2. Launched in 2012 in response to increasing evidence of over utilisation of health care in the US

3. What is Low Value care? Confers little or no benefit on patients
Risk of harm exceeds likely benefit
Costs do not provide proportional benefit
Few interventions are never of benefit
eg Low risk/high risk screening or timing of interventions.
Value = Outcome/Cost

4. Factors that encourage over intervention
Fee for Service healthcare
Activity funded healthcare
Concern over errors of ommision
Patient perception that “more must be better”
Misunderstanding of risks by clinicians and patients

5. 1. Lists of Low Value Investigations and treatments
Evidence based
Developed by the Health Professional Org
2. Consumer/Community Engagement
In partnership with Consumer Reports
Patient centred care

8. Is there low value healthcare in NZ?
Indirect measures (eg Atlas)of utilisation suggest yes.
Limited direct data available but may in future to be available via registries and patient flow data
Medicare data suggests 150 potentially low value practices in Australia and some of these also occur in NZ
Commonwealth Fund Primary Care and Patient Data does suggest we may have less of a problem than other countries

14. Does Choosing Wisely duplicate existing programs ?

15. Choosing Wisely ? Health Professional lead
Collaboration between Health Professionals and Patients/Community
Shared Decision Making

16. Sharing Expertise Clinician Patient Diagnosis Aetiology Prognosis
Treatment options
Outcome probabilities
Patient
Experience of Illness
Social circumstances
Attitude to risk
Goals, values, preferences
Support needs

18. Risk Communication Explain Uncertainty Numbers better than words
Natural frequencies rather than percentages
Specific time frames
Constant denominators rather than nominators
Use both positive and negative framing
Use simple graphics
Individually tailored probabilities adjusted for baseline risk where possible

19. Types of Decision Support
Clinical guidelines
Assumes doctor makes decisions
Evidence based
Describes likelihood of outcomes
Outlines uncertainties
Recommendations based on values of clinical experts
Patient Decision Aids
Assumes shared decision making
Evidence based
Describes likelihood of outcomes
Outlines uncertainties
Does not make recommendations

20. Who should be involved? The Healthcare team
Doctors, Nurses, Pharmacists, Dentists, Physio, Optometrists, Students
Primary Care
Hospitals and other Providers

23. Community awareness Point of Care Campaign Public Campaign
Clinic Posters
Clinic TV
Information leaflets/cards
Patient Decision Aids
Public Campaign
Print, Radio, Television
Website, Facebook, Twitter etc

24. What have we done so far in NZ
Steering committee with broad membership
Engagement with stakeholders
Partnership with Consumer NZ
Initial work on CWNZ image/creative approach
Initial contact with potential funders
Binational Colleges well advanced
Working with NZ only HP organisations

27. Evaluation 3 potential targets at Baseline and Change
Provider Behaviour/utilisation
Clinician attitudes and awareness
Patients perceptions and outcomes

30. Better Conversations Information Deliberation Implementation Reliable
Evidence based
Outlines options, outcomes and uncertainties
Deliberation
Decision support ( personalised care planning )
Implementation
Records , communicates and implemets patients wishes

32. What patients need to know
What are my options
What are the benefits and possible harms
How likely are these benefits and harms
How can you help me make a decision that’s right for me