Overview, Learning Objectives, Reading Assignments, and Resources
Module 8: Strategies Employed by Value Champions
This module provides examples of intervention strategies used by other clinical value champions in their setting to engage providers, staff, and patients in changing their behaviors.
The Taking Action on Overuse Change Package in Module 7 describes many key changes and activities you might consider using when designing your intervention and your activities as a clinical value champion. The purpose of this module is to describe the most common strategies used by RWJF clinical value champion fellows in their projects. (See the Welcome section for a description of the Fellowship and the Fellows.) They are based on a set of well-defined implementation strategies, or methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice. As a clinical champion, you are an example of one well-defined implementation strategy! Much less clearly understood are methods or techniques that a clinical champion can use to enhance the de-implementation of an overuse service. Here we provide you with insider knowledge from clinical value champions that preceded you about what worked for them. It is not meant to be exhaustive, just to provide you with some ideas.
- Describe strategies employed by a group of clinical value champions in safety net settings to reduce overuse.
- Understand how strategies can be combined to complement each other.
- Examine the rationale for selected strategies and how they might be used to overcome common challenges when reducing the use of an overused service.
Watch the six video presentations by each RWJF Clinical Value Champion Fellow describing their project and read through the PowerPoint slides from each.
Overuse of Opioids for Chronic Pain in Primary Care by Roberto Diaz del Carpio, MD
Overuse of Antibiotics for Diabetic Foot Wounds by Leslie Dunlap, PA-C
Appropriate Use of Vascular Access Catheters by George Hoke, MD
Reducing Unnecessary X-Rays for Low Back Pain in the ER by Joshua Mokovitz, MD, MPH, MBA
Unnecessary Use of Over-the-Counter Medicines for Coughs and Colds in Children by Elizabeth Vossenkemper, MSPAS, PA-C
- Citation: Parchman ML, Palazzo L, Austin BT, et al. Taking Action to Address Medical Overuse: Common Challenges and Facilitators. Am J Med. 2020;133(5):567-572. doi:10.1016/j.amjmed.2020.01.001[JW1]
Three strategies that were effective in efforts to reduce unnecessary telemonitoring in the inpatient setting are described.
- Citation: Yeow RY, Strohbehn GW, Kagan CM, et al. Eliminating Inappropriate Telemetry Monitoring: An Evidence-Based Implementation Guide. JAMA Intern Med. 2018;178(7):971–978. doi:10.1001/jamainternmed.2018.2409
This article provides an example of an implementation blueprint designed to reduce the use of unnecessary blood transfusions in the inpatient setting.
- Citation: Sadana D, Pratzer A, Scher LJ, et al. Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program. JAMA Intern Med. 2018;178(1):116–122. doi:10.1001/jamainternmed.2017.6369
The authors discuss effective interventions to reduce inappropriate treatment of asymptomatic bacteriuria.
- Citation: Daniel M, Keller S, Mozafarihashjin M, Pahwa A, Soong C. An Implementation Guide to Reducing Overtreatment of Asymptomatic Bacteriuria. JAMA Intern Med. 2018;178(2):271–276. doi:10.1001/jamainternmed.2017.7290