First statewide report in nation to measure Choosing Wisely® recommendations finds overuse and widespread geographic variation


  • Data from 3.3 million lives in Washington illustrates successes and opportunities for improvement
  • Washington State Choosing Wisely Task Force unveils campaign to focus on imaging for uncomplicated headaches

The first statewide report in the nation to measure Choosing Wisely® recommendations finds that patients in Washington may be exposed to care that they don’t need—and potential harm. The report, Less Waste, Less Harm: Choosing Wisely in Washington State, offers county-by-county results for nine different Choosing Wisely recommendations.

The results are based upon claims data representing 3.3 million lives in Washington state and was issued by the Washington Health Alliance (the Alliance) in conjunction with the Washington State Choosing Wisely Task Force, a group of more than 20 medical leaders from the largest health care organizations in the state. The Task Force is co-sponsored by the Alliance, the Washington State Medical Association (WSMA) and the Washington State Hospital Association (WSHA).

“This report provides a first look into some of the Choosing Wisely recommendations, informing the local and national discussion,” said Nancy A. Giunto, executive director of the Alliance. “Our hope is that this report will spark discussions and initiatives so we can move to a new view in health care, where smarter care equals better care.”

Choosing Wisely® is an initiative of the American Board of Internal Medicine (ABIM) Foundation. The goal of Choosing Wisely is to help providers and patients have conversations about the necessity of tests and procedures and support efforts to help patients make smart and effective care choices. The report was made possible thanks to support from the ABIM Foundation and the Robert Wood Johnson Foundation.

“More care is not always better care. The report shows where we’re doing well in Washington state as well as areas for improvement,” said Brian Seppi, MD, newly-elected president of the WSMA. “Providing quality, safe care for our patients is paramount. Choosing Wisely provides evidence-based guidelines that provide an opportunity for physicians and patients to have candid conversations about what care is appropriate and needed.”

More than 60 national medical specialty societies identified “top five” lists of tests or procedures commonly used in their field whose necessity should be questioned and discussed. The resulting lists of “Things Providers and Patients Should Question” were designed to encourage discussion about the need—or lack thereof—for many frequently ordered tests or treatments.

Among the key findings of the report:

  • Overuse exists. Patients may be getting unnecessary care that costs money and could potentially put them at risk.
  • Variation exists. Often the rates between the lowest and highest performing counties vary by more than twofold.
  • Where you live and the type of insurance you have (commercial vs. Medicaid) may influence the type of treatment you receive.

The report provides a baseline to measure change as Choosing Wisely recommendations inform providers and patients. It is up to clinics and hospital systems to support and implement change within their organizations, and it is up to physicians and patients to consider the recommendations at the time of care.

“Medical officers are very committed to making Choosing Wisely a major focus in Washington state,” said Carol Wagner, RN, WSHA Senior Vice President for Patient Safety. “Physicians still have to make choices based on the individual needs and conditions of their patients, but this data helps to highlight where there is variation and opportunities for improvement.”

To demonstrate that change is possible, the Task Force has launched the Change One Thing initiative, which targets one Choosing Wisely recommendation, “Don’t do imaging for uncomplicated headache,” that participating organizations will focus on implementing in Washington.

The goal is to collaboratively work together on the same recommendation so health care leaders can learn and advance principles that can be applied to other overuse issues and measurably improve the care in Washington. The following organizations are participating to reduce imaging for uncomplicated headaches.

  • WA State Radiological Society
  • North Pacific Pediatric Society
  • WA Association of Physician Assistants
  • WA Chapter American College of Physicians
  • WA Osteopathic Medical Association

“In the state of Washington, we have variation in the care provided for most all conditions that cannot be explained by differences in clinical circumstances or patient preference,” said Matt Handley, MD, medical director for quality at Group Health Cooperative and chair of the Task Force. “We have individual clinicians and medical groups that provide less low value care than others, but there is opportunity for improvement everywhere. Our hope is that we can support a learning community that can help us harness our greatest resource—each other.”

To support physicians seeking to integrate Choosing Wisely recommendations into their practices, the Task Force has developed an action manual that outlines eight steps for leading change that include developing a change vision and generating short-term wins. WSHA and WSMA were leaders in developing the action manual, which is designed to help providers make better-informed decisions with their patients.

About the Washington Health Alliance

As a purchaser-led, multi-stakeholder collaborative with more than 165 participants, the Washington Health Alliance is committed to leading health system change in Washington state. The Alliance has a bold vision: by 2017 physicians, other providers and hospitals in the region will achieve the top 10 percent in performance nationally in the delivery of quality, evidence-based care and in the reduction of unwarranted variation, resulting in a significant reduction in medical cost trends. To achieve this goal, it will require the aligned efforts of those who give, get and pay for health care. A cornerstone of the Alliance’s work is the Community Checkup, a regional report to the public comparing the performance of clinics and hospitals for basic measures of quality care ( The Alliance is a member of the Robert Wood Johnson Foundation’s Aligning Forces for Quality communities. Follow the Alliance on Twitter @WAHealthCheckup.

About the Washington State Medical Association

The Washington State Medical Association’s vision is to make Washington the best place to practice medicine and to receive care. The WSMA represents physicians, physician assistants, residents and students throughout Washington state. Through the WSMA, Washington became the first state in the nation to bring Choosing Wisely to the grassroots level through the Know Your Choices-Ask Your Doctor campaign, a statewide effort to give patients and physicians tools and encouragement to talk about their choices – getting the right care, in the right place, at the right time. For more information about the WSMA, please visit

About the Washington State Hospital Association

The Washington State Hospital Association is a membership organization representing community hospitals and several health-related organizations. The association provides issues management and analysis, information, advocacy and other services. In 2005, WSHA launched the Patient Safety program to help hospitals improve patient safety by supporting the adoption of evidence-based protocols that have been proven to save lives. WSHA works to improve the health of the people of the state by becoming involved in all matters affecting the delivery, quality, accessibility, affordability and continuity of health care. Follow WSHA on Twitter at @WAHospitals and on Facebook at

Media Contacts

John Gallagher
Washington Health Alliance

Susan Callahan

Mary Kay Clunies-Ross

Issued September 24, 2014.

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