What's Next for the Choosing Wisely Campaign?

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Several studies have shown that even after a recommendation is announced, the impact on real-world practice may be small.
Several studies have shown that even after a recommendation is announced, the impact on real-world practice may be small.

While the "Choosing Wisely" campaign continues to bring awareness to unnecessary and harmful healthcare services, the movement "needs to evolve," according to an analysis conducted by a team of researchers from the University of Michigan and Veterans Affairs. Findings from this study were published in the journal Health Affairs.

To date, the Choosing Wisely lists include over 500 tests, scans, prescription drugs, and medical devices that clinicians should avoid along with respective evidence to demonstrate that they are unnecessary for certain patients. However, several studies have shown that even after a recommendation is announced, the impact on real-world practice may be small. In order to "fulfill the promise" of the campaign, the researchers, led by Eve Kerr, MD, MPH, recommend the following:

  • Prioritize recommendations: New recommendations should focus on the most-overused practices, based on actual clinical data, so as to make the biggest impact on care
  • Consolidate recommendations: Groups of professional societies should work together to create recommendations for the care of patients seeking care for the same complaint. For instance, many current recommendations address back pain.
  • Evaluate efforts: Researchers should evaluate the impact of recommendations more rigorously, using methods that can truly let them see if the recommendations are making a difference and if any of them lead to unintended consequences. They should also try to identify barriers to success. While this kind of evaluation should include cost-related impact, cost reduction is not the key goal of Choosing Wisely.
  • Consider patient preferences: Recommendations should take into account patient priorities, and preferred outcomes, front and center with guidelines and in evaluations; make sure patients can understand the recommendations that affect them.
  • Share best practices: Healthcare and government organizations should partner with institutions that are making serious efforts to help their providers follow Choosing Wisely recommendations, and with researchers who can help enhance the innovation and rigor of interventions and evaluations.

Sameer Saini, MD, MS, co-author of the study added, "But changing the behavior of patients, providers, and health systems is not easy. We need to be more thoughtful about how we design programs and interventions to reduce the use of low-value care and be more rigorous and complete in how we assess whether these programs actually worked. At the same time, we need to think about how we will sustain what has been achieved once a program ends. Doing this well is going to require that clinicians, health system leaders, and researchers work together." 

Dr Kerr concluded, "The recommendations so far are a great start and laid the foundation, but we need to focus on using strong methods to identify ones that will make the most difference in quality and value in healthcare, and innovate in the way we change clinical practice and culture."

Reference

Kerr EA, Kullgren JT, Saini SD. Choosing Wisely: how to fulfill the promise in the next 5 years [published online October 24, 2017]. Health Aff. doi:10.1377/hlthaff.2017.0953

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