What methods are used to select the different recommendations that are endorsed by Choosing Wisely? What standard of evidence do you require to support these recommendations?
Medical specialty societies develop their own processes for creating their Choosing Wisely lists of tests and procedures. To ensure consistency and credibility of the lists, the Foundation provides each society with four guidelines to use in their creation. The recommendations need to be: (1) related to frequently done or costly tests or procedures; (2) evidence-based; (3) within the control of the specialty to implement; and (4) created using a transparent process.
As new evidence is developed regarding the effectiveness of different treatments and practices, how will the Choosing Wisely recommendations take these into account?
Medical specialty societies review their lists on a regular basis to ensure they are accurate and make updates to their recommendations in response to new or changing evidence.
Have you evaluated whether the Choosing Wisely recommendations have made an impact on treatment practices, and if so, what have the results been?
Choosing Wisely has always focused on inspiring conversations between clinicians and patients about what care they really need, and, now, more organizations are exploring how to incorporate the recommendations into practice to reduce inappropriate care. We regularly report on clinicians and institutions adopting Choosing Wisely through our monthly newsletter, “Updates from the Field.” Since the newsletter launched in early 2014, it has featured more than 50 stories that include various implementation efforts.10 For example, Kaiser Permanente Georgia reviewed physician practice patterns in relation to Choosing Wisely recommendations and created automated reports on ordering behavior. This intervention led to a 53% decrease in low-back imaging as well as reductions in other unneeded tests. Virginia Mason Medical Center (Seattle, WA) used multiple interventions—including developing a standardize workflow for upper respiratory infections and an antibiotic prescribing report—to cut antibiotic prescribing by half from January 2011 to July 2014. Cedars-Sinai Health System (West Hollywood, CA) programmed its electronic medical record to include 180 Choosing Wisely recommendations. These results are promising, and there are more examples at ChoosingWisely.org.
You just received additional grant funding; what are your plans for using these new funds? What do you see as being the long-term goals of the Choosing Wisely campaign?
Thanks to a second round of funding from the Robert Wood Johnson Foundation, the ABIM Foundation is expanding the Choosing Wisely campaign to engage health systems, hospitals, and medical groups to work with regional health organizations and physician-led groups. Seven initiatives are focusing on reducing the use of antibiotics for viral infections by at least 20% over nearly 3 years in addition to at least two other tests or treatments from Choosing Wisely recommendations.11
Choosing Wisely has helped to create a national conversation about avoiding waste and overuse in health care, and this work continues. We are looking forward to seeing the results of many efforts aimed at moving this education and awareness into projects that implement the campaign recommendations and ideals.
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References
1. Centers for Medicare & Medicaid Services. National Health Expenditure Projections 2014-2024. CMS website. www.cms.gov. Updated July 30, 2015. Accessed March 7, 2016.
2. Kale MS, Bishop TF, Federman AD, Keyhani S. “Top 5” lists top $5 billion. Arch Intern Med. 2011;171(20):1858-1859.
3. Yaraghi N. Why doctors continue to perform unnecessary and expensive tests like prostate cancer screening. U.S. News.
https://www.usnews.com/opinion/blogs/policy-dose/2015/05/27/why-doctors-still-perform-unnecessary-medical-tests. Published May 27, 2015. Accessed March 7, 2016.
4. Henry NL, Braun T, Lusk E, et al. Variation in use of advanced imaging at the time of breast cancer diagnosis in a statewide registry. Paper presented at: 2016
ASCO Quality Care Symposium. February 26-27, 2016. Phoenix, AZ.
5. Sirovich BE, Woloshin S, Schwartz LM. Too little? Too much? Primary care physicians’ views on US health care: a brief report. Arch Intern Med. 2011;171(17):1582-1585.
6. Kim L. Has “defensive medicine” led to overtesting? UCSF News Center. https://www.ucsf.edu/news/2012/08/12566/has-defensive-medicine-led-overtesting. Published August 16, 2012. Accessed March 7, 2016.
7. ABIM Foundation, ACP Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. ABIM Foundation Website. 2005. https://abimfoundation.org/wp-content/uploads/2015/12/Medical-Professionalism-in-the-New-Millenium-A-Physician-Charter.pdf. Accessed March 7, 2016.
8. Institute of Medicine. Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Washington, DC: The National Academies Press, 2013. doi:10.17226/13444.
9. ABIM Foundation. Research Report. Choosing Wisely website. https://www.choosingwisely.org/about-us/research-report/. Accessed March 7, 2016.
10. ABIM Foundation. Updates from the Field. Choosing Wisely website. https://www.choosingwisely.org/resources/updates-from-the-field/?newsletter-category=implementation. Update February 2016, Accessed March 7, 2016.
11. ABIM Foundation. Lists. Choosing Wisely website. https://www.choosingwisely.org/doctor-patient-lists/. Accessed March 7, 2016.
