April 4, 2019
This month marks the seventh anniversary of the Choosing Wisely campaign, which launched on April 4, 2012 to much public fanfare. Nine specialty societies took a courageous step, answering our call for clinicians to identify five things that are done too frequently in their fields and for which there was no evidence of patient benefit.
In the succeeding years, we have watched the campaign evolve beyond our nascent expectations – from an initiative to raise awareness about the extent and perils of overuse in health care, in a partnership that has grown to 87 specialty societies, to actions to change clinical practice.
Around the nation, proponents of Choosing Wisely are using specialty society recommendations as a springboard for initiatives aimed at improving care and patient safety – through a variety of system-oriented approaches (e.g., peer performance data, change in order sets, new clinical pathways, EMR alerts and recognition and reward systems).
While we began Choosing Wisely to prompt a national conversation about overuse in health care and promote greater conversation between patients and physicians about appropriate care, we have achieved so much more through stakeholders who have been inspired to take action to reduce unnecessary tests and procedures.
Specialty society recommendations have climbed to more than 600, with our newest partner releasing its first Choosing Wisely list earlier this year. A variety of recommendations are being implemented and/or promoted by hospital systems, group practices, employer groups, statewide collaboratives, community-based health clinics, accountable care organizations, and the list goes on and on.
Recommendations have been used to narrow or limit order sets for daily labs and diagnostic imaging in inpatient and outpatient settings, develop performance information for peer-to-peer comparisons and develop clinical decision supports within electronic medical record systems. They have inspired conceptual mapping of the harms of overuse, action plans for employers to educate workers about low-value care such as imaging for low-back pain, and the redesign of primary care practice.
One of my favorite implementation stories comes from two academic safety-net medical centers, Los Angeles County and the University of Southern California, where new protocols for cataract surgery resulted in far fewer , pre-operative visits, chest x-rays, EKGs and lab tests – declining absolutely by 71 percent, 75 percent, 74 percent and 55 percent respectively among intervention patients when compared with control patients..
There are many other success stories; we will feature some of the best over the next seven months through case studies of a variety of implementation projects. Look for those stories on the Choosing Wisely website, in our newsletter, and on our social media feeds and Learning Network.
We have formed many more partnerships, including with organizations such as Costs of Care, AcademyHealth, American Hospital Association and the National Alliance of Healthcare Purchaser Coalitions. We look forward to new partnerships in the future.
I’ll close with these points:
- With sizable support from the Robert Wood Johnson Foundation, 14 health systems that have achieved significant reductions from 20 percent to 95 percent by employing a range of system-based approaches.
- Through the Costs of Care’s Choosing Wisely STARS program at Dell Medical School at the University of Texas, Austin, we have seeded student efforts to integrate the tenets of the campaign into 40 medical school programs.
- With our app, we have made recommendations more accessible and portable, hitting more than 10,000 downloads in the first year, and 19 other countries have taken our lead by starting their own Choosing Wisely campaigns.
- Best of all, medical overuse has become so well recognized as a threat to the sustainability of the health care system that hundreds of peer-reviewed articles on overuse appear in wide array of journals. JAMA Internal Medicine has a regular special section called “Teachable Moments: Less is More,” and other publications routinely highlight the best original research on the issue of overuse. The Journal of Hospital Medicine regularly features a column titled “Choosing Wisely: Things We Do for No Reason.”
Not bad for a relatively short period of time. The campaign has turned to stimulating delivery systems and communities to put into practice Choosing Wisely and other recommendations – the really hard work begins.
Daniel B. Wolfson
EVP & COO, ABIM Foundation