1. Tests, Treatments and Procedures; When Less is More Name Site Date Choosingwiselycanada.org Twitter: @ChooseWiselyCA | Email: info@choosingwiselycanada.org 1

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3. $$ Fear of litigation Referring doctor wants it Better to get a test than “do nothing” I’ve always done this Patients want it New tests are good

4. Choosingwiselycanada.org CWA Principles Start small, learn as we go Coordinate partners, physician/ patient input Use data to be effective, improveme nt methods to sustain Patient centered, optimal use focus Show tangible success

5. Choosingwiselycanada.org Three Levels of Implementation C. PCN Demo (Low Back Pain) B. Partner Priorities (Minor Head Injury, LBP, Transfusions, Headache) A. All 102 Topics (17 national societies)

6. Choosingwiselycanada.org A. All Topics Public/Patients AMA Patient Portal website HUTV for health organizations Build on CWC media, posters, and pamphlets Providers Present provincial baseline statistics Provider practice data for self-reflection Develop change supports; EMR, KT, Care Options …

7. Patient Key Messages 7

8. Choosingwiselycanada.org Resources 8 Specific Topics Data Support TOP CPG CWC Patient Pamphlet ACFP Tools for Practice General CWC Supports CWC Patient Pamphlet – Think Again CME: https://www.mdcme.ca/courseinfo.asp?id=155 https://www.mdcme.ca/courseinfo.asp?id=155

9. albertadoctors.org/choosingwisely TopicAlberta Partnership Projects Low Back Pain Bone /Joint SCN via PRIHS I: Spine Access Alberta CWA Demo Project Minor Head Trauma Emergency SCN via PRIHS I: Improving the Stewardship of DI Resources in AB Emerg.Depts. (Minor Head Trauma and Pulmonary Embolism) Vitamin D Implemented April 1 st, 2015 Red Blood Cell Transfusion PRIHS II: Upper GI Bleed; (Transfusion) Uncomplicated Headaches Looking for implementation partners B. CWA Partner Priorities

10. Choosingwiselycanada.org C. Demo Project: Low Back Pain When it came to lower-back MRIs; -about 34 per cent of those tests ordered by family doctors were considered appropriate. -Less than 50 of MRIs ordered by neurologists and orthopedic surgeons had value. -Neurosurgeons had a higher rate of pegging a test’s value, at 75 per cent. - Emery D, Feasby T, 2013, JAMA Internal Medicine 10

11. Don’t do imaging for lower-back pain unless red flags are present.

12. Choosingwiselycanada.org PCN Demonstration -Review ordering patterns -Gather patient and physician input/themes -Providers, patients and PCN plan changes for improvement -Point of care support (EMR, CPG, data info …) -Informed patients (pamphlets, HUTV …) -Care options (physio, standard practices, team processes …) -Coordinated services (referral issues … ) 12

13. albertadoctors.org/choosingwisely Let’s talk … Disseminate CWA topics and pamphlets Choose a CWA topic focus Implement changes for healthy conversations