Choosing Wisely Reaches a Milestone and Looks Toward the Future

The Choosing Wisely® campaign, an initiative of the American Board of Internal Medicine (ABIM) Foundation, recently celebrated five years of encouraging clinicians to reduce overuse of tests, procedures, and treatments that may not benefit patients.

To commemorate the five-year milestone, Health Affairs, which published two papers related to the campaign, sponsored a symposium (“Choosing Wisely: Opportunities and Challenges in Curbing Medical Overuse”) where speakers discussed the campaign’s accomplishments and its future directions.

Today, over 80 medical specialty societies, including the American Society of Hematology (ASH), have issued over 500 recommendations. Each year, ASH selects three Choosing Wisely Champions – individuals who have implemented successful reduction strategies in their practice, institution, or hospital system – to present their work at the ASH annual meeting.

Experts associated with the initiative also acknowledged the continuing efforts to raise awareness of the campaign. According to a paper published in Health Affairs, despite physician outreach efforts, in 2017 only 25 percent of clinicians are aware of the campaign, up four percentage points from 2014. Although most physicians found the Choosing Wisely materials helpful, the number of physicians who reported difficulty in having conversations about avoiding low-value services increased slightly, from 42 percent in 2014 to 46 percent in 2017. Physicians listed malpractice concerns and patient demand as reasons they continue to provide these services.

However, lead author Carrie H. Colla, PhD, noted that there is little evidence that patients are demanding low-value services, or that not offering them increases the risk for malpractice suits: “In terms of future research, it’s important to try to disentangle physician perceptions of the drivers of low-value care versus what’s actually showing up in the empirical research because there’s a definite disconnect.”

In another Health Affairs paper published in connection with the symposium, Eve A. Kerr, MD, from the University of Michigan Medical School and director of the Veterans Affairs Center for Clinical Management Research in Ann Arbor, continued the discussion on the campaign’s remaining challenges and suggested potential solutions, including:

  • incentivizing medical societies to work together to codify their approaches and consolidate recommendations
  • encouraging targeting the root causes of low-value services, leveraging existing behavioral science frameworks, and pursuing cultural change among clinicians and patients via awareness campaigns
  • requiring robust evaluation methods within new studies and encouraging collaboration between stakeholders and researchers to strengthen methods

Source: Medscape, October 25, 2017.