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…

READ:

• 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

WATCH:

• Choosing Wisely “Bite-Sized Learning Modules” from the Patient-Centered Primary Care Collaborative

DO:

• 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…

READ:

• “Enhancing Patient/Clinician Communication: Leveraging Choosing Wisely® as a Tool for Achieving Health Equity”
• “Treating, Fast and Slow: Americans’ Understanding of and Responses to Low-Value Care”

WATCH:

• “Engaging Patients about Overuse at the Point of Care“
• “Empowering Patients to Ask Questions” (Use this for role-play training)

DO:

• Interactive instructional modules can enhance physician and patient communication.
• These simulated encounters from both patient and provider points of view can aid conversations about avoiding unnecessary antibiotics.
• Facilitate small group community conversations

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