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Choosing Wisely Minnesota

Choosing Wisely is a national campaign developed by the ABIM Foundation (American Board of Internal Medicine) to help physicians and patients discuss medical tests and procedures that medical groups say are not needed, overused or maybe harmful. In Minnesota, ICSI, Minnesota Medical Association and the Minnesota Action Group are spreading this campaign as Choosing Wisely Minnesota. All three organizations are among the 21 organizations nationally receiving grants from the ABIM Foundation to spread the national Choosing Wisely® campaign.  The partners are working together to ensure that patients, physicians, and employers in Minnesota are aware of the campaign and its benefits, which include:

  • Supports conversations between clinicians and patients, helping to achieve the Triple Aim of better health, better care and improved costs
  • Helps ensure patient safety and appropriate care for Minnesotans
  • Helps patients know what questions to ask and receive appropriate care
  • Provides clinicians with medical specialty societies’ recommendations and supportive evidence about which procedures and tests to avoid or limit
  • Gives employers and their employees access to easy-to-understand information about health conditions and appropriate health care services
  • Curbs the overuse of health care services that may cause harm and are contributing greatly to rising health care costs

Choosing Wisely Recommendations Addressed in Minnesota

The goal is to help providers, patients and others involved in health care to have conversations about medical tests and procedures that might be unnecessary and may even cause harm. Twenty-six specialty medical groups have identified 135 such tests and procedures. ICSI and The Action Group engaged providers, employers, patients and health plans to review these tests and select those to tackle first, to best ensure appropriate patient care and help Minnesotans realize the Triple Aim of better health, better care and better costs. Some of the criteria used for selection included: strong evidence; emphasis on patient safety and acceptance; emphasis on provider acceptance; not duplicative of other Minnesota health care initiatives; and Choosing Wisely patient-oriented material available.

Initial List of 11 Choosing Wisely Recommendations

  1. Don’t do imaging for low back pain within the first few weeks, unless red flags are present.
  2. CT scans are not necessary in the immediate evaluation of minor head injuries; PECARN criteria should be used to determine whether imaging is indicated.
  3. Don’t do imaging for uncomplicated headache.
  4. Don’t schedule elective, non-medically indicated inductions of labor or C-sections before 39 weeks.
  5. Avoid elective, non-medically indicated inductions of labor before 41 weeks, unless the cervix is deemed favorable.
  6. Don’t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.
  7. Do not repeat colonoscopy for at least five years for patients who have one or two small (<1cm) adenomatous polyps, without high-grade dysplasia, completely removed via a high-quality colonoscopy.
  8. Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.
  9. Don’t recommend more than a single fraction of palliative radiation for an uncomplicated bone metastasis.
  10. Don’t perform stenting of non-culprit lesions during percutaneous coronary artery intervention (PCI) for uncomplicated hemodynamically stable ST-segment myocardial infarction (STEMI).
  11. Avoid routine pre-operative testing for low-risk surgeries without a clinical indication.

Choosing Wisely Patient Resources

Choosing Wisely Provider Resources

Free online CME courses based on Choosing Wisely recommendations

Physician communication skills modules

Health promotions

Choosing Wisely Employer Resources