WATERTOWN, Mass.--(BUSINESS WIRE)--A collaborative of Massachusetts' patients groups, health care providers, payers, and state agencies today launched a month -long awareness campaign aimed at reducing the unwarranted use of diagnostic imaging in the treatment of lower back pain and persistent headaches. The local effort includes more than 20 organizations participating in Choosing Wisely Massachusetts and is being led by Massachusetts Health Quality Partners, a Choosing Wisely grantee of the ABIM Foundation.
“People suffering from lower back pain or frequent headaches want to know what's going on and they want relief,” said Steven Defossez, M.D., Vice President of Clinical Integration, Massachusetts Hospital Association (MHA), a practicing radiologist and MRI specialist. “Cross-sectional imaging tests are powerful tools, which when applied thoughtfully, can result in accurate diagnoses and appropriate care plan formation. Therefore it's not surprising that patients often look to an MRI or CT scan for answers. However, diagnostic imaging may not always be the best option. Over utilization of diagnostic imaging is wasteful at best and may actually be harmful. It's important for patients to work collaboratively with their caregivers, following evidence-based best practices, to get the best outcome.” (See below for medical professional groups’ recommendations.*)
Dr. Paul Hattis, Massachusetts Health Policy Commissioner and public health professor at Tufts University Medical School, sees gaps in understanding that can be bridged by frank conversations. “Patients need to be given the opportunity to express their desires and concerns about testing or treatment options available to them, and providers need to be able to present the evidence and care options in a simple, understandable way,” he says. “It's not easy, but Choosing Wisely Massachusetts has excellent tools available on their website for any patient or doctor who wants to get the conversation started.”
By examining 2013 clinical quality data, Massachusetts Health Quality Partners (MHQP) found that about 20 percent of the imaging tests ordered for lower back pain by the state’s primary care physician practices are not indicated. Barbra Rabson, MHQP’s president and CEO, says, “We know from our years of reporting on quality measures that doctors’ offices vary widely in how they deliver this care, despite the evidence.”
Rabson says that participating organizations and agencies will be disseminating Choosing Wisely information to their constituents – providers, patients, and consumer groups – throughout the month to raise awareness and interest in the campaign.
The collective effort will include the distribution of educational materials developed by medical professional groups to physicians’ offices, health plan members and other consumers across the state, public policy discussions about Choosing Wisely, blog postings and other online communications from supporters, and an active social media campaign, all coordinated by MHQP. MHQP has been leading the Choosing Wisely Massachusetts Campaign for two years with support from the ABIM Foundation and Robert Wood Johnson Foundation.
Several participants summed up the importance of the campaign this way:
“One of the most important imperatives in medicine is to deliver the right care at the right time,” said Richard S. Pieters, MD, president of the Massachusetts Medical Society. “We support the Choosing Wisely Massachusetts campaign because it provides physicians and patients with good information that can be used in their discussions about the benefits and risks of many common procedures and tests.”
“Encouraging conversations between patients and providers so they can make wise decisions about when tests and treatments are helpful and when they are not, supports better, more affordable care for patients and families.” says Dolores L. Mitchell, Executive Director, Commonwealth of Mass Group Insurance Commission.
“Patients and their families want and need to have information like what is readily available from the Choosing Wisely Massachusetts campaign if they are to become better partners informed about care,” says Lucy G. Costa, a member of MHQP’s Consumer Health Council
“This campaign expands on a very positive collaboration among health plans, physicians and their members/patients that promotes consumer engagement and a better understanding of how cost-efficient care is also quality care,” said Matthew Collins, M.D., Senior Medical Director, Fallon Health.
"One of the key lessons we impart to health care professionals, in training and in practice, is the importance of providing high-quality and cost-effective care to patients and populations," says Rosalie Phillips, Executive Director of Tufts Health Care Institute. "For our educational activities in support of high-value care, it is a great benefit to be able to draw upon a resource like Choosing Wisely, with its endorsement by medical societies and its tools for shared decision-making between clinicians and patients."
*Here’s what the evidence tells us about treating lower back pain and persistent headaches:
The American Academy of Family Physicians recommends against diagnostic imaging for lower back pain within the first six weeks unless clearly indicated by other evidence-based factors. They point out that imaging of the lower spine before six weeks does not improve outcomes, but does increase costs and may do more harm than good.(Imaging Tests for Back Pain)
The American College of Radiology points out that most people who seek medical help for headaches have migraines or tension-type headaches. While they can be very painful, all that is usually needed for doctors to diagnose them is a careful medical history and a neurological exam. Adding a CT scan or MRI rarely shows why a headache occurs and it does nothing to ease the pain. A patient might need diagnostic imaging if his or her doctor cannot diagnose the headache based on the exam and medical history, or if the exam finds something that is not normal. (Imaging Tests for Headaches)
Patients can start a conversation with their health care provider by asking these five questions developed by Consumer Reports, a partner in the Choosing Wisely campaign:
- Do I really need this test or procedure? Medical tests help you and your doctor or other health care provider decide how to treat a problem, and medical procedures help to treat it.
- What are the risks? Will there be side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?
- Are there simpler, safer options? Sometimes lifestyle changes, such as eating healthier foods or exercising more can make a difference.
- What happens if I don’t do anything? Ask if your condition might get worse — or better — if you don’t have the test or procedure right away.
- How much does it cost? Ask if there are less-expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.
About Choosing Wisely Massachusetts
Choosing Wisely Massachusetts is a partnership of Massachusetts Health Quality Partners, the ABIM Foundation, Consumer Reports, and health care stakeholder groups in Massachusetts. It is an extension of the ABIM Foundation’s nationally renowned Choosing Wisely® Campaign, a program aimed at helping physicians and patients work together to ensure that an appropriate level of care is delivered at the right time and in the right setting. To do so, Choosing Wisely has compiled lists from various medical specialty societies of evidence-based recommendations to aid physician-patient conversations about what is necessary and appropriate care.
About Massachusetts Health Quality Partners
Massachusetts Health Quality Partners (MHQP) is a non-profit, broad-based coalition established in 1995 that provides reliable information to help physicians improve the quality of care they provide their patients and help consumers take an active role in making informed decisions about their health care. MHQP’s mission is to drive measurable improvements in health care quality, patients’ experiences of care, and use of resources in Massachusetts through patient and public engagement and broad-based collaboration among health care stakeholders, including physicians, hospitals, health plans, purchasers, patient and public advocates, government agencies, and academics.