Evidence map›Paper›PMID 34859435›Full record

ArticleHealth services research2022

Choosing Wisely: An idea worth sustaining.

Monika Kastner, Julie Makarski, Kathryn Mossman, Kegan Harris, Leigh Hayden, Manuel Giraldo, Deepak Sharma, Marwan Asalya, Linda Jussaume, David Eisen and 5 more

Open access · greenAbstract read
In one paragraph

Article in Health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.7field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 9 citations in OpenAlex.

  1. Trial
  2. Observational
  3. Why we all need Choosing Wisely?Internal and emergency medicine · 2023
    Article
  4. Article
  5. Choosing Wisely: An idea worth sustaining.Health services research · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 2 institutions in 1 country.

Monika KastnerKnowledge Translation and Implementation, Centre for Research and Innovation, North York General Hospital, Toronto, Ontario, Canada.ORCID 0000-0002-2838-7417
Julie MakarskiKnowledge Translation and Implementation, Centre for Research and Innovation, North York General Hospital, Toronto, Ontario, Canada.
Kathryn MossmanKnowledge Translation and Implementation, Centre for Research and Innovation, North York General Hospital, Toronto, Ontario, Canada.
Kegan HarrisKnowledge Translation and Implementation, Centre for Research and Innovation, North York General Hospital, Toronto, Ontario, Canada.
Leigh HaydenKnowledge Translation and Implementation, Centre for Research and Innovation, North York General Hospital, Toronto, Ontario, Canada.
Manuel GiraldoPathology and Core Labs, North York General Hospital, Toronto, Ontario, Canada.
Deepak SharmaDecision Support, Health Information Management, North York General Hospital, Toronto, Ontario, Canada.
Marwan AsalyaDecision Support, Health Information Management, North York General Hospital, Toronto, Ontario, Canada.
Linda JussaumeDepartment of Surgery, North York General Hospital, Toronto, Ontario, Canada.
David EisenFamily and Community Medicine, North York General Hospital, Toronto, Ontario, Canada.
Kimberly WintemuteFamily and Community Medicine, North York General Hospital, Toronto, Ontario, Canada.
Edith RolkoDepartment of Pharmacy, North York General Hospital, Toronto, Ontario, Canada.
Phil ShinDepartment of Medicine, North York General Hospital, Toronto, Ontario, Canada.
Jennifer ZadravecDepartment of Medical Imaging, North York General Hospital, Toronto, Ontario, Canada.
Donna McRitchieDepartment of Surgery, North York General Hospital, Toronto, Ontario, Canada.
North York General Hospital · CAUniversity of Toronto · CA

Funding

CIHR
6 · The paper itself

Abstract

objectivesTo evaluate the sustainability potential of Choosing Wisely (CW) to address unnecessary medical care at Ontario community hospitals. DATA SOURCES/STUDY

settingOntario community hospitals and their affiliated family health teams (FHTs). STUDY

designA mixed-methods study involving the administration of a validated sustainability survey to CW implementation teams followed by their participation in focus groups. DATA COLLECTION/EXTRACTION

methodsSurvey data were collected using an Excel file with an embedded, automated scoring system. We collated individual survey scores and generated aggregate team scores. We also performed descriptive statistics for quantitative data (frequencies, means). Qualitative data were triangulated with quantitative assessments to support data interpretations using the meta-matrix method. PRINCIPAL

findingsFifteen CW implementation teams across four Ontario community hospitals and six affiliated primary care FHTs participated. CW priority areas investigated were de-prescribing of proton pump inhibitors (PPIs) and reducing Pre-Op testing and BUN/Urea lab testing. Survey results showed steady improvements in sustainability scores from baseline to final follow-up among most implementation teams: 10% increase for PPI de-prescribing (six FHTs) and 2% increase (three hospital teams); 18% increase in BUN/Urea lab testing (three hospital teams). Regardless of site or CW priority area, common facilitators were fit with existing processes and workflows, leadership support, and optimized team communication; common challenges were lack of awareness and buy-in, leadership engagement or a champion, and lack of fit with existing workflow and culture. All teams identified at least one challenge for which they co-designed and implemented a plan to maximize the sustainability potential of their CW initiative.

conclusionsEvaluating the sustainability potential of an innovation such as Choosing Wisely is critical to ensuring that they have the best potential for impact. Our work highlights that implementation teams can be empowered to influence implementation efforts and to realize positive outcomes for their health care services and patients.

Indexed as

HospitalsHumansOntarioimplementationmixed-methodssustainability

Identifiers

PMID34859435
PMCPMC9108081
OpenAlexW3215041531

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.