Currently Viewing:
Currently Reading
Choosing Wisely Campaign Only Modestly Reduces Unnecessary Services
December 11, 2015 – Jackie Syrop
What We're Reading: CMS Penalizes 758 Hospitals Over Patient Safety
December 11, 2015 – AJMC Staff
One-Third of Americans Still Delay Healthcare Due to Cost
December 11, 2015 – Priyam Vora
What We're Reading: 1 Million New Sign-Ups for ACA Insurance
December 10, 2015 – AJMC Staff
Partial Mastectomy Findings at Yale Could Add Value for Patient and Payer
December 10, 2015 – Surabhi Dangi-Garimella, PhD
Ben Carson's Plans to Repeal Obamacare, Enact Major Changes to Medicare, Medicaid
December 09, 2015 – Laura Joszt
ACS/ASCO Offer Guidelines for Primary Care Clinicians Caring for Survivors of Breast Cancer
December 09, 2015 – Surabhi Dangi-Garimella, PhD
VBID Center Examines Choosing the Right Health Plan
December 09, 2015 – Laura Joszt
Hospital Readmission Rates Depend on Patient Characteristics
December 09, 2015 – Priyam Vora

Choosing Wisely Campaign Only Modestly Reduces Unnecessary Services

Jackie Syrop
The Choosing Wisely campaign seeks to reduce unnecessary medical services but to date hasnít seen much success.
Of 7 treatment and testing services listed by the Choosing Wisely campaign as usually unnecessary, the use of only 2 have decreased, while use of the other 5 either have not  changed or have increased since the campaign began, according to a study in the December 2015 issue of JAMA Internal Medicine.

The Choosing Wisely campaign was created by the American Board of Internal Medicine Foundation in 2012 to help raise awareness and provide a new approach to clinical decision-making, and to help reduce the use of wasteful and unnecessary medical procedures and treatments. Alan Rosenberg, MD, vice president of clinical pharmacy and medical policy at Anthem Inc, and his colleagues analyzed insurance claims data for Anthem-affiliated commercial health plans to see how services deemed low-value by the Choosing Wisely campaign were being used.

From the 70 lists of services or procedures considered by various medical societies to be of minimal clinical benefit in most situations, the investigators chose 7 services:

  • Imaging tests for uncomplicated headache
  • Cardiac imaging without a history of cardiac conditions
  • Low-back pain imaging without red-flag conditions
  • Preoperative chest X-rays with unremarkable history and physical examination results
  • Human papillomavirus (HPV) testing for women younger than 30 years of age
  • Antibiotics for acute sinusitis
  • Prescription nonsteroidal anti-inflammatory drugs (NSAIDs) for patients with hypertension, heart failure, or chronic kidney disease.

In an analysis of at least 10 quarters of claims data for each service on the list, a statistically significant decline was seen in only 2 of the services: imaging for headaches with uncomplicated conditions (decreased from 14.9% to 13.4%; a 10.1% relative reduction) and cardiac imaging in the absence of cardiac disease (decreased from 10.8% to 9.7%; a 10.2% relative reduction). Use of 3 services remained the same (preoperative chest x-rays, lower-back pain imaging, and use of antibiotics for acute sinusitis). However, 2 services actually increased in use: HPV testing in women younger than 30 (25% increase), and use of prescription NSAIDs by patients with 1 or more of the previously identified chronic conditions (12.5% relative increase). The 10 quarters analyzed went up through the third quarter of 2013.

The investigators conclude that additional interventions are needed for wider implementation of Choosing Wisely recommendations, and the authors recommend new measures to effect meaningful change in practitioner knowledge and behavior.

Copyright AJMC 2006-2020 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
Welcome the the new and improved, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up