Communicating information about "what not to do" to consumers.

BACKGROUND: Americans devote more resources to health care than any other developed country, and yet they have worse health outcomes and less access. This creates a perfect set of opportunities for Consumer Reports, a nonprofit consumer advocacy and multimedia organization known for its focus on individual consumers in markets where significant amounts of misinformation is in play. Consumer Reports uses comparisons/ratings based on the best available data to "level" the market playing field. While our early efforts to inform consumers of overuse and underuse in health care were successful, we sensed there were opportunities to have greater impact. Over a 5-year period, with the help of many partners, Consumer Reports learned more about how to communicate "what not to do" to consumers, ultimately enhancing the effectiveness of this difficult message. ANALYSIS: Consumer Reports began an in-depth examination of the overuse of health services in 2010 with an exploratory review of the cognitive psychology literature. Lessons learned from this review were used in the presentation of subsequent ratings of heart disease and cancer screening tests. Surveys showed surprising gaps in the prevention/screening knowledge of healthy, low-risk Consumer Reports subscribers aged 40 to 60 years. Of these subscribers, 44% reported engaging in heart screening tests that received the lowest ratings from the U.S. Preventive Services Task Force and from Consumer Reports. At the same time professional societies and the ABIM (American Board of Internal Medicine) Foundation created Choosing Wisely®, a campaign focused on identifying lists of health tests and treatments not to do. Consumer Reports joined the Choosing Wisely campaign as the consumer "translator" and organizer of a network of consumer organizations with access to tens of millions of consumers. Over the past year, Consumer Reports has conducted multiple qualitative evaluations of content related to overuse of health services. Ratings of cancer screening tests were released in 2013 in an article readers reported as one of the most heavily read articles in the magazine's recent history. CONCLUSIONS: Telling consumers that more is not better is not a popular or easy message to deliver. The message is most likely to be "sticky" but is best received if it comes from trusted sources (e.g., physicians), focuses on safety when justified, is communicated in plain language, and uses both mass media and individual consumer approaches. Changing the culture of health care in an era of health reform is an essential part of the transformation needed if we are to allocate finite resources fairly in hopefully fair markets while assuring that better quality products and services at lower prices dominate.

A new taxonomy for stakeholder engagement in patient-centered outcomes research.

Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.

Suppressing Platinum Electrocatalyst Degradation via a High-Surface-Area Organic Matrix Support.

Degradation of carbon-supported Pt nanocatalysts in fuel cells and electrolyzers hinders widespread commercialization of these green technologies. Transition between oxidized and reduced states of Pt during fast potential spikes triggers significant Pt dissolution. Therefore, designing Pt-based catalysts able to withstand such conditions is of critical importance. We report here on a strategy to suppress Pt dissolution by using an organic matrix tris(aza)pentacene (TAP) as an alternative support material for Pt. The major benefit of TAP is its potential-dependent conductivity in aqueous media, which was directly evidenced by electrochemical impedance spectroscopy. At potentials below ∼0.45 VRHE, TAP is protonated and its conductivity is improved, which enables supported Pt to run hydrogen reactions. At potentials corresponding to Pt oxidation/reduction (>∼0.45 VRHE), TAP is deprotonated and its conductivity is restricted. Tunable conductivity of TAP enhanced the durability of the Pt/TAP with respect to Pt/C when these two materials were subjected to the same degradation protocol (0.1 M HClO4 electrolyte, 3000 voltammetric scans, 1 V/s, 0.05-1.4 VRHE). The exceptional stability of Pt/TAP composite on a nanoscale level was confirmed by identical location TEM imaging before and after the used degradation protocol. Suppression of transient Pt dissolution from Pt/TAP with respect to the Pt/C benchmark was directly measured in a setup consisting of an electrochemical flow cell connected to inductively coupled plasma-mass spectrometry.

Leveraging state cancer registries to measure and improve the quality of cancer care: a potential strategy for California and beyond.

Despite recent increased attention to healthcare performance and the burden of disease from cancer, measures of quality of cancer care are not readily available. In 2013, the California HealthCare Foundation convened an expert workgroup to explore the potential for leveraging data in the California Cancer Registry (CCR), one of the world's largest population-based cancer registries, for measuring and improving the quality of cancer care. The workgroup assessed current registry operations, the value to be gained by linking CCR data with health insurance claims or encounter data and clinical data contained in health system electronic health records, and potential barriers to these linkages. The workgroup concluded that: 1) The CCR mandate should be expanded to include use of its data for quality of cancer care measurement and public reporting; and 2) a system should be developed to support linkage of registry data with both claims data and provider electronic health record data.

Engaging physicians and consumers in conversations about treatment overuse and waste: a short history of the choosing wisely campaign.

Wise management of health care resources is a core tenet of medical professionalism. To support physicians in fulfilling this responsibility and to engage patients in discussions about unnecessary care, tests, and procedures, in April 2012 the American Board of Internal Medicine Foundation, Consumer Reports, and nine medical specialty societies launched the Choosing Wisely campaign. The authors describe the rationale for and history of the campaign, its structure and approach in terms of engaging both physicians and patients, lessons learned, and future steps.In developing the Choosing Wisely campaign, the specialty societies each developed lists of five tests and procedures that physicians and patients should question. Over 50 specialty societies have developed more than 250 evidence-based recommendations, some of which Consumer Reports has "translated" into consumer-friendly language and helped disseminate to tens of millions of consumers. A number of delivery systems, specialty societies, state medical societies, and regional health collaboratives are also advancing the campaign's recommendations. The campaign's success lies in its unique focus on professional values and patient-physician conversations to reduce unnecessary care. Measurement and evaluation of the campaign's impact on attitudinal and behavioral change is needed.

The drug effectiveness review project: an important step forward.

Peter Neumann's paper on the Drug Effectiveness Review Project (DERP) is a constructive if incomplete point of departure for discussing the work done by the project and the use of that work by decision-makers in states and elsewhere. This Perspective attempts to establish the proper context for judging the DERP by comparing its product and processes with those commonly produced and used by industry and other parties. It also provides a direct response to the criticisms of the project noted by Neumann.