• Scott Pugel, John L Stallworth, Leslie B Pugh, Carlee Terrell, Zuwere Bailey, Thomas Gramling, and Helen Ward.
• Jt Comm J Qual Patient Saf. 2018 Dec 1; 44 (12): 699-707.

BackgroundScant evidence exists of effective Choosing Wisely® initiatives, which are intended to reduce the use of unnecessary care. In 2013 substantial variations existed at Kaiser Permanente Georgia in the frequency of nonbeneficial services in ambulatory care. A Choosing Wisely campaign was implemented across 25 medical offices serving approximately 300,000 members.MethodsThe initiative was designed to reduce the use of complete blood counts (CBCs) and electrocardiograms (EKGs) as routine screening tests in physical examination visits, age-inappropriate dual-energy x-ray absorptiometry (DEXA) scans, and imaging for uncomplicated headache. The change management package consisted of (1) guideline selection by clinical leaders, (2) continuing medical education for clinicians and training and education for clinic staff and advice nurses, (3) an internal and external communication plan, and (4) monthly reports.ResultsBetween January 2013 and December 2016, CBC use as a routine screening test decreased by 39.5 percentage points (95% confidence interval [CI] = 39.0-40.0)-from an average of 42.7% to 3.2%; EKG use as a routine screening test decreased by 15.5 percentage points (95% CI = 15.1-15.8)-from an average of 15.9% to 0.3%; inappropriate DEXA scan use decreased by 23.4 percentage points (95% CI = 22.5-24.5)-from an average of 25.4% to 2.0%; and imaging for uncomplicated headache decreased by 3.9 percentage points (95% CI = 3.3-4.6)-from an average of 10.8% to 6.9%. All decreases were statistically significant (p < 0.05) and were largely sustained after monthly reports ended.ConclusionSustained reductions in nonbeneficial services in ambulatory care followed implementation of a comprehensive change management package.Copyright © 2018 The Joint Commission. Published by Elsevier Inc. All rights reserved.

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