Characterization of the Recommendations in the Choosing Wisely Initiative

Abstract

Choosing Wisely is a comprehensive set of recommendations that guides clinicians and patients away from low-value services. The recommendations were reviewed to investigate their breadth and limitations. The authors performed an abstraction of all Choosing Wisely recommendations between March 1 and May 27, 2016. Descriptive statistics were used to characterize various topics found in the recommendations. Of the 461 Choosing Wisely recommendations, 48% targeted workup studies, 26% non–medication management, 20% medication management, and 6% disease prevention. The most commonly targeted medical issues were coronary artery disease (9%), antibiotics overuse (8%), back pain (6%), breast cancer (5%), and prostate cancer (4%). A limited focus was found on disease prevention and a lack of alignment with health care quality measures. Characterization of Choosing Wisely revealed a comprehensive set of recommendations that addresses low-value care across many specialties. Ultimately, this study provides guidance for promoting the creation and implementation of more patient-centered, representative recommendations.

Characteristics and Trends Among Patients With Cardiovascular Disease Referred to Palliative Care

“…Practices use a random sampling technique to input patient data into the registry, minimizing selection bias and representing a broad sampling of clinicians, patients, diseases, and care settings. Data elements are mapped to several national quality measures, including those endorsed by the National Quality Forum, included in federal payment programs, 12 produced or curated by national membership societies, 13 , 14 and proposed by expert panels. 15 , 16 , 17 , 18 Members of Global Palliative Care Quality Alliance join voluntarily, pay membership dues, and have minimum data submission expectations to participate.…”

Outcomes of both complex and isolated cases of infants with large stomach on fetal ultrasound

“…Per the Choosing Wisely campaign, medical practices should have specific evidence to support their use. 17 This approach led to the questioning of the significance of other soft markers, including echogenic intracardiac focus and choroid plexus cyst. 16,18 Studies looking at the significance of isolated markers led to the Society for Maternal-Fetal Medicine guidelines recommending against following up these markers in women at low risk for aneuploidy, in whom these findings are considered to be a normal variant.…”

A scoping review characterizing "Choosing Wisely®" recommendations for breast cancer management

“…Additionally, even in the small number of publications reporting positive clinical impact, the assessed population is loco-regional and not expandable beyond centers [83]. Lastly, it is unclear how much impact these cost-value analyses had on creating recommendations for Choosing Wisely®, as the process of selecting "top" recommendations does not explicitly comment on weightage of cost benefit in decision-making [30]. Thus, to implement these cost-value analyses in a direct fashion and to allow for direct inclusion of a guideline proposed by a national organization as CW, we would recommend a set of criteria that, if met, would qualify the guideline for direct consideration by ABIM or CW® International: a certain percentage reduction in the cost of care per quarter, reduction on absolute and relative adverse events in patient care, ease of adherence, and population characteristics for each recommendation to accommodate differences in international populations.…”