Welcome to Iowa’s Choosing Wisely Campaign
The Choosing Wisely® Campaign is an initiative aimed to help physicians, patients, and other healthcare stakeholders to think and talk about overuse of health care services. Choosing Wisely® promotes wise choices by clinicians in order to improve health care outcomes, provide patient-centered care that avoids unnecessary and even harmful interventions, and reduce the rapidly-expanding costs of the health care system.
Healthcare is a complex and quick paced environment with new treatments, diagnosis tools, and tests developed every day. The temptation to use the latest and “greatest” methods or to run multiple tests to ensure accurate diagnosis is strong. Patients may request tests or treatments that may not be necessary or in their best interest. Providers (physicians, nurse practitioners, physician assistants, etc.) often struggle with decisions about prescribing tests and procedures as a way of covering all possible bases. Despite the best of intentions, more care does not always mean better care.
As part of the Choosing Wisely Campaign, Iowans have access to evidence-based recommendations of frequently misused tests and procedures for patients and providers to discuss thoroughly before using and resources to help patients and providers in having the necessary conversations to ensure the most appropriate and best quality of care.
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The goal of Choosing Wisely is about having conversations about health and wellness and making informed choices. These conversations should not just happen around issues of injury and short-term illness, but should also include discussions about care decisions for serious illness and advance planning for end-of-life care.
Palliative care is a type of coordinated, multi-specialty care that focuses on providing relief from symptoms, pain, and the physical and mental stress of serious and/or complex illness, such as cancer, Alzheimer’s Disease, heart disease, and others. The goal of palliative care is to improve the quality of life for people living with serious illness, regardless of age or stage of illness, and their families.
Check out the resources below from Choosing Wisely and others for more information about palliative care.
Palliative Care: Support at Any Time During a Serious Illness (American Academy of Hospice and Palliative Medicine)
When you get palliative care, a trained team helps you and your loved ones live with a serious illness. Palliative care can improve your quality of life and may help you live longer.
- English: Palliative Care: Support at any time during a serious illness
- Spanish: Cuidados Paliativos: Apoyo en cualquier momento durante una enfermedad grave
Palliative and Hospice Care: Comfort During a Serious Illness or the Final Months of life
A patient and family information handout from Consumer Reports Health and the National Hospice and Palliative Care Organization.
An information website provided by the Center to Advance Palliative Care (CAPC) that offers clear, comprehensive palliative care information for people coping with serious, complex illness. Includes a provider directory, handouts for patients and families, and an interactive questionnaire to assist in determining if palliative care is right for you or a loved one.
The Conversation Project
A collaborative project helmed by the Institute for Healthcare Improvement (IHI) dedicated to helping people talk about their wishes for end-of-life care, including discussions related to palliative care and hospice care. Includes valuable tools for both patients and their families to start the conversation both with each other and their healthcare provider.
Patients have a valuable role in partnering with physicians to advocate for their best health. As part of this partnership, patients and providers should have conversations about their health care, including information about their specific conditions and options for testing and treatment, throughout the care process and before any orders are made.
Choosing Wisely has great resources to assist patients in having those discussions, including “5 Questions to Ask Your Doctor Before Getting Any Test, Treatment, or Procedure”:
1. Do I really need this test or procedure? — Medical tests help you and your doctor or other health care provider decide how to treat a problem. And medical procedures help to actually treat it.
2. What are the risks? — Will there be side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?
3. Are there simpler, safer options? — Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more.
4. What happens if I don’t do anything? — Ask if your condition might get worse — or better — if you don’t have the test or procedure right away.
5. How much does it cost? — Ask if there are less-expensive tests, treatments or procedures, what your insurance may cover, and about generic drugs instead of brand-name drugs.
Choosing Wisely has also put together a convenient “5 Questions” and “When to say “whoa” to your doctor” wallet card. Click here to download and print the card.
Estimates suggest that as much as $750 billion dollars a year is spent on wasteful medical care in the United States – or one-third of all US health care spending (Institute of Medicine, 2012). The Choosing Wisely campaign is part of a national effort by the ABIM Foundation (American Board of Internal Medicine). The campaign is part of the ABIM Foundation’s goal of encouraging clinicians to think more carefully about medical care options and choose wisely to improve health care outcomes, provide patient-centered care that avoids unnecessary and even harmful interventions, and reduce the rapidly-expanding costs of the health care system.
Since its inception in 2012, more than 60 medical specialty organizations have partnered with ABIM and the Choosing Wisely® campaign to establish their top recommendations for services and treatments that providers should be certain to thoroughly consider before prescribing.
Through collaboration with Iowa Medical Society and direction from a Choosing Wisely physician work group, a list of five recommendations most important to Iowans was identified.
1. Don’t obtain imaging studies in patients with non-specific low back pain; and don’t do imaging for low back pain within the first six weeks, unless red flags are present.
2. Don’t do imaging for uncomplicated headache. Imaging headache pains absent specific risk factors for structural disease is not likely to change management or improve outcomes.
3. In the evaluation of simple syncope and a normal neurological examination, don’t obtain brain imaging studies (CT or MRI).
4. Avoid unnecessary use of computed tomography (CT) scans in the immediate evaluation of minor head injuries.
5. Don’t order sinus CT or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
Additional information about the Choosing Wisely campaign in Iowa can be found on the Iowa Healthcare Collaborative Choosing Wisely initiative page.
Resources by Topic
The following is a collection of Choosing Wisely recommendations and consumer resources related to the “Iowa 5” and other leading recommendations.
Antibiotics: When You Need Them and When You Don’t
When and how to use antibiotics to help you and your loved ones avoid drug resistance.
- Plain English: Antibiotics: When You Need Them and When You Don’t
- Plain English: Antibiotics: When You Need Them and When You Don’t (Complete Package)
- Spanish: Antibióticos: Cuándo se necesitan y cuándo no
CT Scans for Children with Head Injuries (AAP)
For children with head injuries, a CT scan often is not needed.
- Plain English: CT Scans for Children with Head Injuries (AAP)
Imaging Tests for Back Pain (AAFP)
It seems like getting an X-ray, CT scan or MRI to find the cause would be a good idea.
- Plain English: Imaging Tests for Back Pain
- Spanish: Pruebas radiológicas debido a dolor en la parte baja de la espalda
Imaging Tests for Headaches (ACR)
Many with severe headaches want a CT scan or MRI to see if they have a tumor or other serious problem.
- Plain English: Imaging Tests for Headaches (ACR)
- Spanish: Pruebas de Imágenes para Dolores de Cabeza
Treating Sinusitis (AAFP)
Millions of people are prescribed antibiotics each year for sinusitis.
- Plain English: Treating Sinusitis (AAFP)
- Spanish: Cómo tratar la sinusitis
- Video: Treating Sinusitis
- Video: Para tratar la sinusitis
Unnecessary Treatments in the Emergency Room (ACEP)
Three procedures commonly used in the emergency room are unnecessary in many cases.
- Plain English: Unnecessary Treatments in the Emergency Room (ACEP)
- Spanish: Evite tratamientos innecesarios en la sala de emergencias
The Choosing Wisely campaign in Iowa is being led by the Iowa Healthcare Collaborative (IHC) through a two-year grant from the ABIM Foundation to advance the Choosing Wisely campaign. Support for this program comes from the Robert Wood Johnson Foundation.
IHC is a provider-led and patient-centered patient safety and quality improvement organization dedicated to promoting a culture of continuous improvement in healthcare. As part of the Choosing Wisely campaign in Iowa, IHC will work to educate healthcare professionals, provide tools and resources about the Choosing Wisely campaign, and work to align current quality improvement strategies, with campaign strategies, to improve patient care statewide.
For more information about Choosing Wisely in Iowa, visit the IHC Choosing Wisely initiative page.
If you would like more information about the Choosing Wisely campaign or are interested in becoming a campaign partner, please contact:
Kady Hodges, MPH
Choosing Wisely Project Director
Iowa Healthcare Collaborative