Taking Action on Overuse: A Framework for Change (for Health Orgs & Institutes)

It has been a while since I discovered any new organizations doing work on the topic of overdiagnosis and the related issues of overtesting and overtreating. Many different projects and initiatives explore the subject; some, like Choosing Wisely, make lists of 'do not do' recommendations. Others, like Minimally Disruptive Medicine provide thoughtful reflection and model practices to show us how to burden our patients less and engage them more. The Lown Institute and their Right Care Alliance work at many levels, be it in political advocacy, cultural change, or clinical education. 

The Right Care Alliance is sponsored by the Robert Wood Johnson Foundation, something it has in common with Taking Action on Overuse.  While the former is more directed at patients, clinicians, and policy-makers, Taking Action on Overuse is a group that seems devoted to supporting health organizations and institutions. Organizations interested in creating changes to provide fewer unnecessary or harmful tests, treatments, and procedures, can employ the tools Taking Action has created. 

In their words, "Taking Action on Overuse is an evolving framework for health care organizations to engage their care teams in reducing low-value, unnecessary care and make those efforts last. It identifies evidence-based strategies for obtaining buy-in, motivating behavior changes, and providing the necessary support and infrastructure for health care providers to engage and lead their peers in making the changes that improve the value of health care."

Their Assessment can help you figure out whether your institution is ready with best practices, and gently guide you there. Likewise, their Framework can help you create the right conditions for change in a climate where many still believe "more is always better."

Check out their website here to learn more.

Source: https://takingactiononoveruse.org/

Projects and Initiatives toward Appropriateness in Medicine: Health Quality Ontario

When I started this website, the ambition was to collect and curate information. So much fantastic research and advocacy has already been undertaken in the area of Appropriateness in medicine, but there was no "one-stop shop" for it.

This growing movement is known by many names, like RightCare, Quaternary Prevention, Overdiagnosis, Appropriateness, Less is More in Medicine, and so on. In Canada, we seem to favour the "Appropriateness in Health Care" phrase.

The field now has so much momentum that it can be hard to keep track of everything. It's a great problem to have when you are passionate about this way of thinking, but as I'm only one person I can miss lots of great things! A friend pointed out a glaring (and wonderful, Canadian) omission:

It is the Health Quality Ontario Appropriateness Initiative, which created a systematic framework for identifying, prioritizing and assessing interventions that are potentially being used inappropriately; they offer evidence reviews and recommendations. Some topics include Measuring HbA1cs in Diabetes and Testing Vitamin B12 Levels in Neuropathy, Alopecia, Dizziness, and Fatigue.

There are many other initiatives, beyond this one and the fairly well-know Choosing Wisely campaign. See the list of PROJECTS for more.