The Impact of the Choosing Wisely Campaign Recommendations on Supplemental Oxygen Management

Passive dissemination of information is commonly used to influence clinical practice. Our objective was to assess whether passive dissemination of the Choosing Wisely Campaign recommendations to reassess hypoxemia before renewing post-discharge supplemental oxygen impacted receipt of oxygen reassessment or oxygen appropriateness. We conducted a cohort study of all patients with inpatient COPD exacerbation at a VA facility between October 2010 and September 2019 and primary care visits within 90 days. The primary outcome was oxygen reassessment within 90 days of hospital discharge, defined as measurement of either partial pressure of oxygen by blood gas analysis (PaO2) or oxygen saturation by pulse oximeter (SpO2). Our secondary outcome was home oxygen appropriateness at 90 days post-discharge, defined as continuation of supplemental oxygen for those with hypoxemia (PaO2≤55 mmHg or SpO2≤88%) at rest or with exertion. We used the CWC publication month of October 2013 as the time of intervention to conduct an interrupted time series analysis using multivariable logistic regression to estimate pre-CWC trends, immediate change at the time of intervention, and post-CWC trends. We adjusted for age, gender, ethnicity, race, Elixhauser comorbidity score, rural residence, and primary care facility complexity. We identified 21,429 patients who met our inclusion criteria. Pre-CWC, 65.8% (4,600/6,992) received oxygen reassessment within 90 days of discharge, 17.4% (799/4,600) of whom met oxygen appropriateness criteria. There was no significant change in oxygen reassessment or oxygen appropriateness over time pre-CWC, no immediate change in at the time of intervention, and no change in trend post-CWC. The Choosing Wisely Campaign’s recommendation for post-discharge oxygen management was not associated with a change in home oxygen reassessment or prescription practices. Our findings support existing research showing that passive dissemination of recommendations alone is a weak intervention for behavior change. Health systems should consider active knowledge translation strategies for implementation of evidence-based care.