Reducing Low-Value Care in Vulnerable Populations – Changing Care in Practice

The resources below can help safety-net practices, hospitals and systems implement a quality improvement (QI) project to decrease low-value care. They have been broken into sections by time commitment:

  • If you have five minutes, check out our top five insights from each area.
  • If you have twenty minutes, read sample scripts, review tools or listen to a short podcast.
  • If you have an hour to dedicate, read the source journal articles, watch a webinar or join our learning network to connect with others.

If you have five minutes…

Consider these five things when implementing a Choosing Wisely QI project:

Identify the problem: consider working to reduce frequently unneeded testing or treatments that occur at least 40% of the time in your institution.

Consider “balancing” overuse and safety measures with “do no harm” messaging, and/or pairing a low-value care reduction initiative with efforts to increase high-value care (e.g. promoting evidence-based preventive screening).

Use a multi-intervention model when implementing quality improvement efforts to reduce low-value care.

Incorporate Choosing Wisely into practice workflows.

Engage patient and family advisors in planning and implementing your improvement efforts.

If you have 20 minutes…


  • Our Choosing Wisely Top 12 recommendations for reducing low-value care
  • The CW Implementation Toolkit developed by Quality Counts includes tools to integrate Choosing Wisely into your workflow.
  • Sample scripts can help practice staff and clinicians have Choosing Wisely conversations with patients (See page 4 of Quality Counts’ Choosing Wisely Implementation Toolkit).
  • Our poster from an Academy Health meeting on reducing low-value care
  • The Commonwealth Fund Low-Back Pain case study
  • Choosing Wisely implementation case studies from San Francisco and Maine. (TK)
  • The AMA’s Steps Forward toolkit includes recommendations for team-based implementation efforts.
  • Choosing Wisely toolkits by the Washington State Medical Association



  • Place “Commitment Posters” in exam and waiting rooms to show your organization’s commitment to reducing inappropriate use of antibiotics.
  • Place posters, flyers and cards in waiting or exam rooms, or give them to patients as handouts.

If you have 60 minutes…