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Quality, Safety & Value


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Hypoglycemia Safety Initiative (HSI)

Choosing Wisely is a collective effort of professional societies whose goal is to reduce medical tests and treatments that are harmful or of marginal value.  The Veterans Health Administration (VHA) has embraced this initiative, establishing a Choosing Wisely Task Force.  Led by Dr. Len Pogach and Dr. Gordon Schectman, the VHA Choosing Wisely is a multi-disciplinary effort that welcomes input from several VHA program offices:  Nursing Services, Office of Patient Care Services, Pharmacy, and National Center for Health Promotion and Disease Prevention.

The VHA has chosen to target glycemic overtreatment as one focus, with an emphasis upon hypoglycemic safety. The VHA “Hypoglycemia Safety Initiative” (HSI) supports a concern first addressed by VA/Department of Defense guidelines for Diabetes in 1997 and now recognized as a national health problem by the Department of Health and Human Services (HHS), which itself has developed a National Action Plan National Action Plan in collaboration with all Federal Agencies. The ultimate goal of these voluntary efforts is to foster evidence-based, patient-centered, critical clinical thinking and shared informed decisions between VHA healthcare teams, clinicians and Veterans.

Roughly 50 percent of Veterans with diabetes being treated with medications have comorbidities including age greater than 75, renal dysfunction (serum creatinine>2.0 mg/dl), diabetic complications, cognitive impairment, and other serious medical or mental health conditions which increase their risk of serious hypoglycemia.  About 50 percent of these Veterans have laboratory evidence (A1c less than 7 percent) of intensive management that increases risk of hypoglycemia without significant benefit.

The VHA Choosing Wisely Task Force proposes a voluntary program to improve patient-centered care and support Patient-Aligned Care Teams (PACTs) across the country. The program includes an action plan to reach both Veterans and their healthcare teams and to provide them with the necessary tools to help effect change.  Although HSI is an internal (VA) effort, we hope that all clinicians will recognize the importance of improving safety for patients at risk for hypoglycemia, and to consider adopting similar initiatives to treat the non-Veteran population.

National VA Press Release

For more information, please contact Mark McConnell, MD at

Choosing Wisely

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