When it comes to medical tests and procedures, less can sometimes be better.
According to a new report released this week, Ontario health care providers are successfully working to provide and improve quality care by reducing unnecessary care to patients across Ontario.
Released by Health Quality Ontario and Choosing Wisely Canada, the report, Spotlight on Leaders of Change: Implementing Choosing Wisely Canada Recommendations in Ontario to Improve Quality of Care, includes examples of successful programs implemented by clinical leaders to address unnecessary care in hospitals, primary and long-term care settings.
There is growing recognition that unnecessary care is common in health systems around the world, including Canada. The American-based Institute of Medicine estimates that up to 30% of medical care may be classified as unnecessary, at times introducing preventable risks associated with that care.
Health Quality Ontario defines high-quality care as safe, effective, efficient, patient-centred, timely and equitable. Reducing unnecessary care aligns with this definition of quality, as does engaging patients in decisions concerning their care. Unnecessary care is defined as care in which there is a lack of benefit or in which benefits are outweighed by the potential risks, including patient inconvenience, increased cost to the health care system, and even potential harm to patients.
Choosing Wisely Canada launched a national, clinician-led campaign in 2014 to help patients and clinicians talk more openly about tests, treatments and procedures so that they, and their families, can make informed choices about the care they receive.
This work has shown, for example, that 30% of Ontarians received potentially unnecessary cardiac tests and blood work before low risk, non-cardiac surgery. And, according to the report, unnecessary tests are not confined to hospitals. The report also notes that in primary care, 21% of Ontarians had bone mineral density testing not covered by practice guidelines.
Reducing unnecessary care also saves money. Savings from ordering tests and procedures only when they are needed can be redirected to other needed patient care.
“This program has been a win-win for all stakeholders in our pre-operative program,” says Dr. Lloyd Smith, Chief of Surgery, North York General Hospital.
North York General Hospital’s program, “Pre-operative Quality Improvement Initiative for Surgical Patients” was developed after it was found that more than 70% of elective surgery patients seen in its pre-operative clinic received medically unnecessary tests and procedures. The program has resulted in a 38% decrease in pre-operative testing in low-risk patients undergoing low-risk surgical procedures.
Dr. Joshua Tepper, President and CEO of Health Quality Ontario, believes that “Choosing Wisely, implemented well, has the potential to significantly advance the provincial quality agenda. It is a great partnership opportunity not only for Health Quality Ontario, but for providers, patients and organizations across the healthcare system.”
Many clinicians in Ontario have contributed to the national effort to develop the Choosing Wisely Canada recommendations. Efforts in Ontario will now focus on how recommendations can be adopted.
With a goal to better support the delivery of safer and more effective care, Health Quality Ontario helped bring together partner organizations and early leaders to look at and understand the causes of unnecessary care. The hope is for this report to inspire others to implement report recommendations within their own organizations.
On April 6, The Canadian Institute for Health Information and Choosing Wisely Canada will release a joint national report on unnecessary care in Canada. Ontario joins many other provinces in Canada as part of the Choosing Wisely Canada campaign.