North Carolina Healthcare Quality Alliance

Non-profit health collaborative North Carolina Healthcare Quality Alliance (NCHQA)  partnered with the North Carolina Medical Society (NCMS), Duke MedicineCornerstone Health CareBlue Cross Blue Shield of North Carolina and the State Health Plan for Teachers and State Employees to reduce the use of:

  • antibiotics to treat viral infections in adults;
  • DEXA scans to measure bone density in women younger than 65 and men younger than 70;
  • carotid artery stenosis screening in asymptomatic patients; and
  • annual Pap tests for women between the ages of 30 and 65.


Key Interventions

The partners worked to achieve reductions through a number of interventions focused on patient education, provider education, electronically integrated clinical decision-making tools and changes to the health system culture.

To reach consumers, project partners placed posters and patient brochures in all of their primary care and urgent care sites. They also included links to Choosing Wisely materials in the online reminders patients receive before their visits from their patient portal.

Organizations with statewide reach—such as Blue Cross Blue Shield of North Carolina (3.8 million customers) and the North Carolina State Health Plan for Teachers and State Employees (more than 685,000 members and dependents)—disseminated information about Choosing Wisely through newsletters, mailings, blog posts and more. Meanwhile, the NCMS disseminated Choosing Wisely messaging to state and regional medical societies and health care organizations.


Stories of Success

The Next Generation at Duke

By reducing the use of unnecessary or potentially avoidable tests and treatments, Duke Health leaders intended to improve the care their patients – and all North Carolinians – receive. To achieve that, the Choosing Wisely effort led by the North Carolina Healthcare Quality Alliance, with Duke as a key participant, aimed to improve patient and clinician education, transform system processes, and foster community-based dialogues between patients and clinicians about making smarter health care choices.

Duke placed a special emphasis on engaging physicians at the beginning of their medical careers. In many of its residency programs, a high-value care curriculum was implemented through a series of lectures with interactive cases, delivered by inpatient and outpatient division faculty. Duke used the three services selected for this grant as specific case examples and the curriculum was the basis for two program-wide initiatives under the Choosing Wisely campaign.

“I definitely think that being a resident gives me a unique perspective on the project,” said Alyson Shogan, MD, MBA. “I’m still forming the way I practice and approach discussions with patients. And as a resident, I’m in education and training on a day-to-day basis. So whether it’s lectures, or group projects, or even one-on-one teaching, I’m always working on which teaching methods work best, and how they can integrate into the physicians’ already busy day, all under the scope of Choosing Wisely.”


In Their Own Words