title: Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely.
abstract: BACKGROUND
  The Choosing Wisely campaign encourages physicians to avoid low-value care. Although widely lauded, no study has examined its impact on clinical decisions made in primary care settings.
  
  
  METHODS
  We compared clinical decisions made for 5 Choosing Wisely recommendations over two 6-month time periods before and after the campaign launch and an educational intervention to promote it at 3 primary care residency clinics.
  
  
  RESULTS
  The rate of recommendations adherence was high (93.2%) at baseline but did significantly increase to 96.5% after the launch. These findings suggest primary care physicians respond to training and publicity in low-value care, though further research is needed.
  
  
  CONCLUSIONS
  Given that even small decreases of physician test ordering can produce large cost savings, the Choosing Wisely project may help achieve the health care triple aim.
authors.affiliation: From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS). akost@uw.edu.
authors.forename: Amanda
authors.initials: A
authors.lastname: Kost
authors.affiliation: From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS).
authors.forename: Inginia
authors.initials: I
authors.lastname: Genao
authors.affiliation: From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS).
authors.forename: Jay W
authors.initials: JW
authors.lastname: Lee
authors.affiliation: From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS).
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Smith
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods*; D003363:Cost Control; D020000:Decision Support Systems, Clinical; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D015397:Program Evaluation; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data*
keywords: Cost Control; Decision Making