90 Tests and Treatments to Question

WASHINGTON, D.C. – Seventeen leading medical specialty societies have identified specific tests, procedures or medication therapies they say are commonly ordered, but which are not always necessary—and could cause undue harm. To date, more than 130 tests and procedures to question have been released as part of the ABIM Foundation’s Choosing Wisely^® campaign, which aims to spark conversations between patients and physicians about what care is really necessary.

Each specialty society participating in Choosing Wisely identified five specific tests or procedures that are commonly done in their profession, but whose use should be questioned. In April 2012, nine medical specialty societies each released Choosing Wisely lists.

The new lists, to be released Thursday at a Washington, D.C., press conference, include recommendations such as:

Don’t schedule non-medically indicated inductions of labor or cesarean deliveries before 39 weeks, 0 days of pregnancy. Delivery prior to 39 weeks is associated with increased risk of learning disabilities, respiratory problems and other potential risks. While sometimes induction prior to 39 weeks is medically necessary, the recommendation is clear that simply having a mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery. (American College of Obstetricians and Gynecologists; American Academy of Family Physicians)
Don’t use feeding tubes in patients with advanced dementia. Studies show that percutaneous feeding tubes do not result in better outcomes for these patients. The recommendation states that assistance with oral feeding is a better, evidence-based approach. (American Academy of Hospice and Palliative Medicine; American Geriatrics Society)
Don’t perform routine annual Pap tests in women 30 – 65 years of age. In average-risk women, routine annual Pap tests (cervical cytology screenings) offer no advantage over screenings performed at three-year intervals. (American College of Obstetricians and Gynecologists)
Don’t automatically use CT scans to evaluate children’s minor head injuries. Approximately 50 percent of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may escalate future cancer risk. The recommendation calls for clinical observation prior to making a decision about needing a CT.(American Academy of Pediatrics)
Avoid doing stress tests using echocardiographic images to assess cardiovascular risk in persons who have no symptoms and a low risk of having coronary disease. The recommendation states that there is very little information on the benefit of using stress echocardiography in asymptomatic individuals for the purposes of cardiovascular risk assessment, as a stand-alone test or in addition to conventional risk factors. (American Society of Echocardiography)
When prescribing medication for most people age 65 and older with type 2 diabetes, avoid attempting to achieve tight glycemic control. The recommendation states that there is no evidence that using medicine to tightly control blood sugar in older diabetics is beneficial. In fact, using medications to strictly achieve low blood sugar levels is associated with harms, including higher mortality rates. (American Geriatrics Society)
Don’t perform EEGs (electroencephalography) on patients with recurrent headaches.Recurrent headache is the most common pain problem, affecting up to 20 percent of people. The recommendation states that EEG has no advantage over clinical evaluation in diagnosing headache, does not improve outcomes, and increases costs. (American Academy of Neurology)
Don’t routinely treat acid reflux in infants with acid suppression therapy. Anti-reflux therapy, which is commonly prescribed in adults, has no demonstrated effect in reducing the symptoms of gastroesophageal reflux disease (GERD) in infants, and there is emerging evidence that it may in fact be harmful in certain situations. (Society of Hospital Medicine)

“Twenty-five of the nation’s leading medical specialty societies have now spoken up and shown leadership by identifying what tests and treatments are common to their profession, but not always beneficial,” said Christine K. Cassel, MD, president and CEO of the ABIM Foundation. “Millions of Americans are increasingly realizing that when it comes to health care, more is not necessarily better. Through these lists of tests and procedures, we hope to encourage conversations between physicians and patients about what care they truly need.”

The organizations releasing lists today represent more than 350,000 physicians:

*Releasing a second list.

All of the recommendations were developed by the individual specialty societies after months of careful consideration and review. Using the most current evidence about management and treatment options within their specialty, the societies believe the recommendations can make a significant impact on patient care, safety and quality. The 25 specialty societies that have now released lists are undertaking considerable efforts to share the recommendations with their collective membership of more than 725,000 physicians. The campaign is also reaching millions of consumers nationwide through a stable of consumer and advocacy partners.

Consumer Reports—the world’s largest independent product-testing organization—has used itswebsite and magazine to amplify the campaign’s key messages. Consumer Reports has also collaborated with specialty societies to publish more than 35 free easy-to-understand brochures and other online resources for dissemination to both English- and Spanish-speaking consumers. In a Consumer Reports survey of 2,669 consumers who received Choosing Wisely information, 72 percent agreed that it had changed their opinion of the topic, taught them new information, or prompted them to ask more questions of their health provider. Eighty-one percent of consumers reporting interest in a Choosing Wisely topic said they were likely to have a conversation with their physician about what they had read. The survey was fielded in December 2012.

Consumer Reports has worked with the ABIM Foundation to maximize the campaign’s reach and impact through its network of consumer-facing partner organizations including:

“In less than a year, more than 70 million consumers have received practical advice about medical tests and treatments that are often overused or inappropriate,” said James A. Guest, JD, president and CEO of Consumer Reports. “It’s a thrill to be working with the ABIM Foundation on Choosing Wisely. And we applaud the courage of the specialty societies for addressing overuse and encouraging informed patient-doctor dialogue.”

In addition, the campaign announced that the Robert Wood Johnson Foundation has given a $2.5 million, 28-month grant to the ABIM Foundation to advance Choosing Wisely. The grant will fund medical specialty societies and regional health improvement collaboratives to work in specific communities to raise awareness of potential overuse of medical care, and stress the importance of conversations between physicians and patients about appropriate care. The grant will also strengthen Consumer Reports’ efforts to produce and disseminate plain-language information about overuse.

“Reducing the overuse of health care resources is a critical part of improving quality of health care in America,” said Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation. “We want to see what can happen when this work is targeted in specific geographic regions and are pleased to help increase the tangible impact of the Choosing Wisely campaign.”

The campaign also announced specialty societies who will release new lists later in 2013:

*Releasing a second list.

**Releasing a third list.

The complete lists from the specialty societies, available at www.ChoosingWisely.org, include additional detail about the recommendations and evidence supporting them.

Leading Medical Specialty Societies Identify 90 Tests and Treatments to Question

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