STUDY: Health Systems are using Choosing Wisely® Recommendations to Reduce use of Low-Value Medical Services

Health care systems should be optimistic that interventions designed to reduce unnecessary medical tests, treatments and procedures recommended by specialty societies as part of the ABIM Foundation’s Choosing Wisely campaign can produce meaningful results for their organizations, according to new research published in The Milbank Quarterly.

“The Impact of Choosing Wisely Interventions on Low-value Medical Services: A Systematic Review,” examined 131 published articles on Choosing Wisely’s impact between its inception in 2012 and June 2019. Researchers have found that active interventions (65%) were more likely to generate reductions in overuse than merely disseminating Choosing Wisely recommendations (13%). Among active interventions, those with multiple components (77%) were more successful than those with one component (47%).

Additional findings include:

  • Most of the studied Choosing Wisely interventions focused on changing the behavior of clinicians or operations of health care systems.
  • Interventions that were notable and described in the review were changes in order sets, clinical decision support, clinical champions, academic detailing, creation of clinical pathways and clinical feedback or report cards.
  • There is a need for high-quality studies that include active controls.
  • The impact of clinician-focused interventions appeared to be more pronounced than the impact of consumer-focused interventions.

Researchers suggest disseminating Choosing Wisely guidelines alone does little to reduce low-value care.

Choosing Wisely has been praised for involving multiple stakeholders, including specialty societies in developing recommendations to avoid unnecessary medical tests, treatments and procedures. The ABIM Foundation launched the initiative in 2012 to advance a national dialogue on these issues.

To date, the campaign has engaged more than 80 medical specialist organizations and produced over 600 recommendations to reduce over-utilized services and improve patient care.

Supported by the ABIM Foundation, the research was conducted by Betsy Q. Cliff, School of Public Health, University of Illinois Chicago, Anton L. V. Avanceña, School of Public Health, University of Michigan, Richard A. Hirth, School of Public Health, University of Michigan, and Shoo-Yih Daniel Lee, College of Health Professions, Virginia Commonwealth University.


About The ABIM Foundation

The ABIM Foundation’s mission is to advance medical professionalism to improve the health care system by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policymakers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit, connect on Facebook or follow on Twitter.


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