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…




If you need assistance with this toolkit or implementing Choosing Wisely in your practice or system, please contact Kate Carmody at