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HSR&D Citation Abstract

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Choosing Wisely and Maximizing Value: Lessons from the US Veterans Health Administration Healthcare System.

Kressin N, Wilt TJ, Kinsinger L, McConnell M, Partin MR, Morgan D, Aron D, Pogach L, Kerr E. Choosing Wisely and Maximizing Value: Lessons from the US Veterans Health Administration Healthcare System. Presented at: Preventing Overdiagnosis Annual Conference; 2015 Sep 1; Bethesda, MD.

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Objectives: The US Department of Veterans Affairs (VA) is the nation's largest integrated healthcare system. Recently, the VA adopted a "Blueprint for Excellence", emphasizing the importance of value in VA care, and of providing evidence-based care to patients who can benefit, while refraining from providing harmful or low value practices. Similarly, the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign emphasizes the importance of identifying and reducing the use of low-value and potentially harmful services. VA clinicians, operations leaders, and researchers are now working together to "Choose Wisely" and maximize the value of VA care. Methods: We will describe the concepts and definitions of value, overuse, and overtreatment, suggesting a framework for evaluating screening, diagnosis and treatment "intensity", which facilitates assessments of the balance between intensity and value (optimizing benefits for incremental harms and costs). In some situations more intensity is needed, while in others lower intensity is better value. We will describe a perspective for appropriately balancing benefits with harms and costs that accompany an intervention (but are often unrecognized/reported/assessed). Presenters will describe ongoing VA efforts to maximize value, using case studies to exemplify the issues in conducting such work, including successes from and barriers to such efforts. Results: The VA has initiated efforts to reduce overuse of PSA testing and is now developing an approach to maximizing the value of lung cancer screening. A Choosing Wisely/Hypoglycemia Safety Initiative aims to reduce the percentage of high risk diabetes patients receiving over-intensive treatment, which has resulted in a notable 8% reduction in patients at high risk. Conclusions: There are many successes of and barriers to maximizing value in a large healthcare system like VA; we will share suggestions for others who seek to do so in their own systems and invite discussion.

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