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A statewide controlled trial intervention to reduce use of unproven or ineffective breast cancer care. Contemp Clin Trials 2016 09;50:150-6 PMID: 27521808 PMCID: PMC5565266

Pubmed ID

27521808

Abstract

BACKGROUND: Challenged by public opinion, peers and the Congressional Budget Office, medical specialty societies have begun to develop "Top Five" lists of expensive procedures that do not provide meaningful benefit to at least some categories of patients for whom they are commonly ordered. The extent to which these lists have influenced the behavior of physicians or patients, however, remains unknown.

METHODS: We partner with a statewide consortium of health systems to examine the effectiveness of two interventions: (i) "basic" public reporting and (ii) an "enhanced" intervention, augmenting public reporting with a smart phone-based application that gives providers just-in-time information, decision-making tools, and personalized patient education materials to support reductions in the use of eight breast cancer interventions targeted by Choosing Wisely® or oncology society guidelines. Our aims are: (1) to examine whether basic public reporting reduces use of targeted breast cancer practices among a contemporary cohort of patients with incident breast cancer in the intervention state relative to usual care in comparison states; (2) to examine the effectiveness of the enhanced intervention relative to the basic intervention; and (3) to simulate cost savings forthcoming from nationwide implementation of both interventions.

DISCUSSION: The results will provide rigorous evidence regarding the effectiveness of a unique all-payer, all-age public reporting system for influencing provider behavior that may be easily exportable to other states, and potentially also to large healthcare systems. Findings will be further relevant to the ACO environment, which is expected to provide financial disincentives for ineffective or unproven care.

TRIAL REGISTRATION: ClinicalTrials.gov number pending.

Author List

Pezzin LE, Laud P, Neuner J, Yen TW, Nattinger AB

Authors

Purushottam W. Laud PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Ann B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Joan Neuner MD, MPH Associate Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Medicine department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-84981731350   1 Citations

MESH terms used to index this publication - Major topics in bold

Age Factors
Breast Neoplasms
Clinical Decision-Making
Comorbidity
Consumer Health Information
Humans
Internet
Mobile Applications
Patient Education as Topic
Quality of Health Care
Socioeconomic Factors
jenkins-FCD Prod-300 626508253d14e4184314fb9f66322a03a5906796