How Can I Implement Choosing Wisely In My Practice or Health System?

implement-cw-practiceWhether looking to implement Choosing Wisely on a large or small scale, the following resources can help guide physicians looking to align their practice with the campaign.

Getting Started

  • The Institute for Clinical and Economic Review completed an analysis of several of the Choosing Wisely recommendations that explore current practice variation and costs, and examine the sociological forces that contribute to the overuse of the tests and treatments. Each report also includes a summary rating of the extent and harms of overuse, the difficulty of practice change, and the potential for savings. (These recommendations might be a good starting place for deciding which recommendations to focus on implementing.)
  • ABIM Foundation staff identified a “Top 12” list of Choosing Wisely recommendations that drove the largest decrease in unnecessary tests and procedures.
  • Email Washington State Health Alliance to request technical specifications that include 11 claims-based measures of Choosing Wisely recommendations and three clinical-based measures. All are updated to ICD-10. If you are interested in implementation, these measures are all Choosing Wisely-specific.

Guides and Toolkits

  • These case studies offer practical examples of efforts to reduce overuse across a wide range of topics, and can be helpful learning tools for your own implementation strategies. They can aid practices and systems in:
    • assessing which tools, engagement strategies and quality improvement techniques might work in their your home settings,
    • addressing implementation barriers
    • anticipating unexpected consequences, and
    • identifying strengths you can build on.
  • The Washington State Medical Association and the Washington State Choosing Wisely Task Force developed resources outlining several recommend actions that physicians, hospitals, health care organizations and payers can take to reduce unnecessary pre-op testing, including clinical team education, EHR prompts, checklists and more.
  • This resource from North Carolina Healthcare Quality Alliance includes a clinician implementation plan, activities to consider for your community and examples specific to reducing antibiotic use.
  • Greater Detroit Area Health Council’s Learning Guide to Social Impact Assessment for Community Health aims to advance progress toward population health improvements through the expanded capture, sharing, and use of electronic health data from diverse sectors. It is part of a series developed by CHP SME communities – highlighting their practical experiences, noting key lessons, and sharing insights relevant to those working as part of local initiatives to improve population health.
  • These resources by Essential Hospitals aid in improved cost of care conversations among clinicians and patients.
  • Screensavers such as this one at Henry Ford can be utilized in healthcare settings to promote awareness of overuse reduction.
  • This guide from the Institute for Patient- and Family-Centered Care outlines information about working with patient and family advisors to improve Choosing Wisely implementation.
  • A summary of the 2017 Connecticut Choosing Wisely Collaborative‘s “Call To Action” Summit details insights and recommendations around implementing Choosing Wisely to empower and engage underserved populations. Topics include ways to engage the care team, empower consumers and target campaign marketing.
  • Part of its Steps Forward set of practice improvement strategies, the American Medical Association created a module to help physicians advance Choosing Wisely in their practice. (CME available)
  • The American Society for Clinical Pathology created this online toolkit to promote the campaign in the community. Included are links to articles and blog posts, implementation guides, handouts and posters available for download, among other resources.
  • For physicians or other health care leaders struggling with how to integrate Choosing Wisely‘s evidence-based best practices into their practices or organizations, this guide from the Washington State Choosing Wisely Task Force provides a step-by-step approach to making system-level changes.
  • The Task Force has also created a toolkit that provides primary care, specialty care and school-based clinics guidelines for prepping the care team from appointment-making to checking patients out.
  • This report details alignment to Choosing Wisely recommendations in Washington state county-by-county. The goal of the report is to inform local discussions about appropriate health care.
  • These guides and scripts for both faculty and students aid in discussions with medical students about treating lower back pain, sinus infections, testing for headaches, pap tests and cardiac testing.
  • Using Choosing Wisely Tools to Empower Patients” by Maine Quality Counts is an implementation toolkit for teams and includes Choosing Wisely practice workflow and scripting, getting started resources and marketing resources for patient and clinical settings.
  • Our neighbors to the North, Choosing Wisely Canada, have created a series of toolkits to provide a starting place for implementation by clinicians who have achieved significant impact in implementing a Choosing Wisely recommendation in their setting.
  • “Advancing the Choosing Wisely campaign in Clinical Practices and Communities” details the stories of success and lessons learned from the first round of Choosing Wisely grantees, 21 projects that sought to educate physicians about the campaign.

How Do I Talk To Patients About Choosing Wisely?

  • This handout from Health Insight Utah allows patients to record their up-to-date medical information (primary care provider, enrollment assister and insurance plan) and easily reference the Choosing Wisely ‘5 Questions to Ask Your Doctor Before You Get Any Test, Treatment or Procedure.”
  • Essential Hospitals created this toolkit to support healthcare personnel in recognizing opportunities for cost conversations, responding to cost questions and/or redirecting and referring cost questions to the appropriate health system personnel.
  • This module from Qualidigm aims to “provide participants with an understanding of how to advance cost of care conversations in the practice setting to improve patient outcomes. The learning module includes practical tools that participants can employ with their practice and identifies behaviors to model in order to best support team members in cost of care conversations.”
  • These tools from Essential Hospitals can improve cost of care conversations among clinicians and patients.

Learn From Others

  • Stories of Choosing Wisely implementation across the country, from small individual practices to large health systems, can help those looking to implement campaigns of their own.
  • The Choosing Wisely Champions program recognizes clinicians or teams of clinicians for their significant contributions to advancing the goals of the campaign.
  • Email us to join our Choosing Wisely Learning Network, which includes a bi-monthly webinar series highlighting the work of past and current grantees who are implementing the campaign in their community or system, and expert guests sharing best practices for reducing overuse. Learning network members also have access to a shared virtual space and receive a monthly resource email and the Choosing Wisely Connect email.

Other Resources to Address Overuse

  • Taking Action on Overuse is a framework for health care organizations to engage their care teams in reducing overused, unnecessary care and make those efforts last. It identifies evidence-based strategies for obtaining buy-in, motivating behavior changes, and providing the necessary support and infrastructure for health care providers to engage and lead their peers in making the changes that improve the value of health care.
  • Health Partners’ podcasts include skilled versions of patient-clinician interactions that demonstrate how conversations might typically go in a busy practice. They also highlight optimal approaches for addressing conversations on overuse and include a debrief in which the hosts reflect on the differences in tone, style, language and patient validation.
  • The Centers for Disease Control and Prevention’s “U.S. Antibiotics Awareness Week” campaign addresses the dangers of unnecessary antibiotics. This information can be used in conjunction with the Choosing Wisely materials to help inform providers about the push to reduce antibiotics prescriptions.
  • Modules created by Kognito walk users through simulated encounters from either the patient or provider point of view to aid conversations about avoiding unnecessary antibiotics.
  • Part of its Steps Forward set of practice improvement strategies, the American Medical Association created a module to help physicians advance Choosing Wisely in their practice.
  • These interactive instructional modules were intended to enhance physician and patient communication around the specialty society recommendations from the Choosing Wisely campaign.

     

 

Learn more:

Where Should I Start?
Information on the origins of the campaign, accounts from early adopters, and anecdotes from patients on the effects of overtreatment

Am I Choosing Wisely?
Learning modules for clinicians that help them hone communication skills, avoid unnecessary testing and overcome barriers to delivering high-value care

How Can I Implement Choosing Wisely in My Community?
Information for community organizations and employers looking engage patients in the campaign

How Can I Implement Choosing Wisely in My Workplace?
Resources for employers to educate their employees about avoiding overuse