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also prompted a look at the overuse of diagnostic imaging among what he described as emergency department “super-utilizers.” Some patients, for example, received dozens of CT scans in a single year. At TMA’s urging, the Texas Insti-


tute of Health Care Quality and Effi- ciency (www.ihcqe.org) also adopted Choosing Wisely in its legislative recommendations for the state’s ver- sion of health care reform. The cam- paign dovetails with the institute’s task of identify- ing and promoting evidence-based ap- proaches to improve health care qual- ity, accountability, education, and cost containment in Texas. The institute also included Choos- ing Wisely in its strategic plan for im-


proving health literacy among patients, which also could help identify and reduce variations in care utilization across the state, says Dr. Fullerton, a consultant to the board.


“This actually helps save time and money, and it’s better medicine.”


JUST GETTING STARTED Mr. Wolfson says TMA continues to be a key partner as the ABIM Founda- tion works to over- come challenges to furthering the program, such as a lack of health liter- acy. With medicine being a team sport, physicians also can help build other partnerships as nonphysician pro-


fessions come into the fold, he adds. For example, physical therapists


and dentists have joined Choosing Wisely. Also, the American Academy of Nursing chose Texas as the pilot


state for its entry into the campaign. At press time in mid-December, the


ABIM Foundation also announced a second round of grants to expand the “next generation” of Choosing Wisely “beyond educating and raising aware- ness of over-utilization of key tests and treatments to measuring and demonstrating reductions in inappro- priate utilization for those services.” Support for the seven $315,000 grants also comes from RWJF, and applica- tions began in January. TMA shared the grant notice with members (tma


.tips/CWgrants). Physician leaders agree: Education


and awareness are one thing, but sus- tained change requires more. That means taking the Choosing


Wisely recommendations from paper to practice, Dr. Torres says. “We’re just scratching the surface.” Dr. Fullerton agrees some form of


measurement is important to advance the campaign’s and physicians’ suc-


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