title: A statewide controlled trial intervention to reduce use of unproven or ineffective breast cancer care.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  ClinicalTrials.gov number pending.
authors: Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, United States. Electronic address: lpezzin@mcw.edu.
authors: Liliana E
authors: LE
authors: Pezzin
authors: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, United States.
authors: Purushottam
authors: P
authors: Laud
authors: Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, United States.
authors: Joan
authors: J
authors: Neuner
authors: Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, United States; Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
authors: Tina W F
authors: TW
authors: Yen
authors: Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, United States.
authors: Ann B
authors: AB
authors: Nattinger
mesh_terms: D000367:Age Factors; D001943:Breast Neoplasms / Q000628:therapy*; D000066491:Clinical Decision-Making; D015897:Comorbidity; D054626:Consumer Health Information / Q000379:methods*; D006801:Humans; D020407:Internet; D063731:Mobile Applications; D010353:Patient Education as Topic / Q000379:methods*; D011787:Quality of Health Care / Q000592:standards*; D012959:Socioeconomic Factors
keywords: Breast cancer; Choosing Wisely®; Complex intervention; Controlled trial; High-value health care