September 22, 2011
As part of its effort to help physicians and patients “choose wisely” about health care resources, the ABIM Foundation, in partnership with the Council of Medical Specialty Societies, has awarded five grants to a diverse group of health care organizations for projects to advance professionalism among practicing physicians as part of its Putting the Charter into Practice initiative.
Grant recipients include Johns Hopkins Bayview Medical Center, the American College of Physicians, National Physicians Alliance, Costs of Care (a non-profit organization located in Boston) and the University of Minnesota’s Division of Pediatric Emergency Medicine.
These grants will facilitate the development of innovative, emerging strategies to advance appropriate health care decision-making and the stewardship of health care resources, one of the commitments of Medical Professionalism in the New Millennium: A Physician Charter. Authored by the ABIM Foundation, in partnership with the American College of Physicians Foundation and the European Federation of Internal Medicine, the Physician Charter promotes the primacy of patient welfare, patient autonomy and social justice. It also articulates the professional responsibilities of physicians, including a commitment to improving quality and access to care, advocating for a just and cost-effective distribution of finite resources and maintaining trust by managing conflicts of interest.
The Physician Charter states: “While meeting the needs of individual patients, physicians are required to provide health care that is based on the wise and cost-effective management of limited clinical resources.”
With its grant, Johns Hopkins Bayview will focus on reducing the overutilization of cardiac enzyme panels, a commonly ordered diagnostic test, by aligning physician ordering behavior with established guidelines for appropriate testing and changes in billing systems. Low performers will receive coaching; high performers will be interviewed to identify best practices. The project team will evaluate the effort based on cardiac enzyme test ordering pre- and post-intervention.
“Providers must strive to deliver health care in a way that ensures a just distribution of limited resources. This project aims to reduce a significant inefficiency in the practice of medicine – overutilization of diagnostic laboratory testing – with regard to the evaluation of patients with acute coronary syndrome,” says Jeff Trost, M.D., assistant professor of cardiology and deputy director for clinical practice in the Department of Medicine at Johns Hopkins Bayview. “For a variety of reasons, providers sometimes order more lab tests than are needed to make or exclude the diagnosis of acute coronary syndrome, which includes patients with chest pain and/or patients suspected of having a heart attack. Our project aims to educate providers about the existing guidelines regarding appropriate lab ordering, create an electronic barrier to prevent overuse, and provide feedback to providers about their ordering behavior. By reducing overutilization of diagnostic testing, we save patients money, time and needle sticks.”
The projects initiated by Putting the Charter into Practice grantees come at a critical time for the U.S. health care system. According to the Centers for Medicare & Medicaid Services, national health care expenditures are projected to increase from 17.3 percent of the nation’s GDP in 2011 to 19.3 percent in 2019.
“Improving the use of finite resources is crucial to addressing the unsustainable growth of our health care system,” said Christine K. Cassel, M.D., president and CEO of the American Board of Internal Medicine and ABIM Foundation. “The tools developed by the Putting the Charter into Practice grantees will equip physicians with the competencies and system support needed to engage patients and families in choosing wisely about their health care decisions.”
Putting the Charter into Practice grants awarded in 2011 continue the Foundation’s investment in organizations advancing tenets of the Physician Charter. In 2009 the Foundation awarded six grants to institutions for projects that addressed the challenges physicians face in delivering patient-centered care, managing the distribution of finite health care resources, handling unprofessional behavior and other complicated ethical situations.
To learn more about the ABIM Foundation and the Putting the Charter into Practice grantees, visit the Foundation’s Web site at www.abimfoundation.org.