Choosing Wisely: assessment of current US top five list recommendations’ trustworthiness using a pragmatic approach

Abstract

ObjectivesIdentification of sufficiently trustworthy top 5 list recommendations from the US Choosing Wisely campaign.SettingNot applicable.ParticipantsAll top 5 list recommendations available from the American Board of Internal Medicine Foundation website.Main outcome measures/interventionsCompilation of US top 5 lists and search for current German highly trustworthy (S3) guidelines. Extraction of guideline recommendations, including grade of recommendation (GoR), for suggestions comparable to top 5 list recommendations. For recommendations without guideline equivalents, the methodological quality of the top 5 list development process was assessed using criteria similar to that used to judge guidelines, and relevant meta-literature was identified in cited references. Judgement of sufficient trustworthiness of top 5 list recommendations was based either on an ‘A’ GoR of guideline equivalents or on high methodological quality and citation of relevant meta-literature.Results412 top 5 list recommendations were identified. For 75 (18%), equivalents were found in current German S3 guidelines. 44 of these recommendations were associated with an ‘A’ GoR, or a strong recommendation based on strong evidence, and 26 had a ‘B’ or a ‘C’ GoR. No GoR was provided for 5 recommendations. 337 recommendations had no equivalent in the German S3 guidelines. The methodological quality of the development process was high and relevant meta-literature was cited for 87 top 5 list recommendations. For a further 36, either the methodological quality was high without any meta-literature citations or meta-literature citations existed but the methodological quality was lacking. For the remaining 214 recommendations, either the methodological quality was lacking and no literature was cited or the methodological quality was generally unsatisfactory.Conclusions131 of current US top 5 list recommendations were found to be sufficiently trustworthy. For a substantial number of current US top 5 list recommendations, their trustworthiness remains unclear. Methodological requirements for developing top 5 lists are recommended.

Protection against the overuse and underuse of health care – methodological considerations for establishing prioritization criteria and recommendations in general practice

“…A multiple-step prioritization algorithm was developed based on the methodological recommendations made by the aQua-Institute for developing and evaluating quality indicators [ 19 ]. During this process the answers from both the guideline panel and the naive panel were combined.…”

“…Physicians’ associations are committed to the rational and moderate use of health care services, as can be seen in initiatives such as “Choosing Wisely” in the USA, “Smarter Medicine” in Switzerland and “Choosing Wisely Together (Gemeinsam Klug Entscheiden)” in Germany [ 17 – 19 ]. “Choosing Wisely” and “Smarter Medicine” have published lists of widely overused health care services and aim to steer doctor-patient communication towards this topic.…”

A multi‐level strategy for a long lasting reduction in unnecessary laboratory testing: A multicenter before and after study in a teaching hospital network

“…4,[21][22][23] In the context of the Choosing Wisely Campaign, an initiative launched by the American Board of Internal Medicine aimed to target unnecessary low value investigations and treatment and to promote conversation between patients and providers, several medical societies have recommended against routine laboratory testing in hospitalised patients. [24][25][26] The Swiss Society of General Internal Medicine, under the name of Smarter Medicine/Choosing Wisely Switzerland, joined the Campaign in 2014 and published twice a list of five high-risk interventions to be avoided in the ambulatory and hospital care setting, respectively. 27 In one of these recommendations the Swiss Society of General Internal Medicine invited physicians to avoid ordering blood tests at regular intervals or to perform routine extensive lab panels without specific clinical questions.…”

“…The most successful were those that implemented multifaceted approaches involving a combination of 3 strategies: education, audit, and feedback on provider ordering practices, and restrictive ordering options in the electronic prescription tools . In the context of the Choosing Wisely Campaign, an initiative launched by the American Board of Internal Medicine aimed to target unnecessary low value investigations and treatment and to promote conversation between patients and providers, several medical societies have recommended against routine laboratory testing in hospitalised patients . The Swiss Society of General Internal Medicine, under the name of Smarter Medicine/Choosing Wisely Switzerland, joined the Campaign in 2014 and published twice a list of five high‐risk interventions to be avoided in the ambulatory and hospital care setting, respectively …”

Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE)

“…While the initiative has not gone without criticism, i.e. not all recommendations have been developed with standardized methodology or undisputed evidence [43], and other recommendations are perceived as difficult to implement [44], the initiative still represents an important attempt to reduce overutilization of medical interventions, including laboratory testing, that are not expected to be beneficial for the patients.…”