To celebrate the four years since the Bree Collaborative began with Washington State House Bill 1311, we are dedicating our July 22nd meeting to looking at where we started, at our successes across the State, and to discussing where we’re headed.

We hope you can join us at Cambia Grove in two weeks!

Where We Started

Our Collaborative is modeled after the Advanced Imaging Management Project. In 2009, medical and governmental leaders became concerned about increased use of procedures like CT, PET, and MRI without any evidence of improved patient health or lower death rates. Leaders had concerns about issues like unnecessary duplication of imaging and inappropriate use of tests.[1] Increased use of these procedures can expose patients to unnecessary harm.

Dr. Robert Bree was a member of this project team and a radiologist at Harborview Medical Center. He helped the project develop ways to reduce unneeded use of these procedures, making care safer and more affordable for all Washingtonians. Our Collaborative is named in his honor.

Find out more about this project here:

Like this project, our Collaborative looks at inappropriate use, unnecessary care, and procedures that may be harmful to patients. However, instead of looking at ways to improve only advanced imaging, we can find ways to improve multiple different health care issues – from heart surgery, to screening for addiction, to cancer care.

Where We Are

Our Collaborative has worked on many important topics. Appropriately, we first looked at improving the way babies are born in Washington State. Our goals were to reduce unnecessary care that may result in harms to moms and babies like early elective deliveries, elective inductions of labor, and C-sections that are not needed. We are looking forward to learning more about the ways that maternity care has improved in Washington State at our July 22nd meeting from the Washington State Hospital Association.

On the other end of the spectrum, we have also looked at end-of-life care in our State. We profiled these recommendations briefly in our blog post Planning for Future Health Care and look forward to learning how Honoring Choices® Pacific Northwest is working with community partners to make sure that the care you want is the care you receive. Everyone deserves to be informed about their end-of-life options, communicate their preferences in actionable terms, and receive end-of-life care aligned with their goals and values.

We have also developed recommendations to tie provider and hospital payment to an entire episode of care including potential complications resulting from poor care. This is very different from our current health care model that pays physicians and other providers for the number of services provided rather than quality of care.  We call these bundled payment models and we have focused on total knee and total hip replacement, lumbar fusion, and are currently developing a model for coronary artery bypass surgery. At our July 22nd meeting we look forward to discussing how our bundled payment models have been used across our state and will vote on disseminating our current model for public comment.

Low back pain, profiled in our first blog post Pain in the Back: When is health care treatment too much?, is a great example of how our recommendations can be championed and endorsed by community groups. The Northwest Healthcare Purchasers Coalition based in Spokane, Washington has gathered a group of dedicated organizations and are working towards adopting our recommendations into their current practice. We will learn more about this project at our upcoming meeting. More information here:

Where We’re Headed

Choosing new topics is always an exciting time for the Bree Collaborative. After we celebrate our successes, we will have a short talk about where we should head next. We choose three topics each year where there is:

– Variation that serves no purpose,
– High rates of use or increases in use that are not necessary,
– Waste or inefficiency in care delivery,
– Patient safety issues, or
– Inappropriate care.

We will continue this discussion at our September meeting and officially vote on our new topics at that time.

Do you have ideas for new Bree Collaborative topics? We want to hear from you at our meeting, through email, or through our website here:

Hope to see you on July 22nd!

Ginny Weir, MPH
Program Director, Bree Collaborative

[1] Washington State Health Care Authority. Advanced Imaging Management Project. Available: Accessed: June 2015.