In 2012, the American Board of Internal Medicine (ABIM) Foundation, in partnership with Consumer Reports, founded the Choosing Wisely® campaign, to raise awareness among physicians and patients about avoiding unnecessary tests, treatments, and procedures. The Institute of Medicine estimates that up to 30 percent of care in the United States is waste. At the campaign’s five-year mark, Health Affairs is releasing two articles on what has and has not been accomplished in this effort. Both studies will also appear in the journal’s November issue.
Valuable For Providers Who Knew About It, But Awareness Remained Constant
In this study, the authors evaluated telephone surveys of physicians, administrated in 2014 and 2017 by ABIM to examine physicians’ attitudes toward and awareness of the use of low-value care. The share of physicians who were aware of the Choosing Wisely campaign increased a modest 4 percentage points, from 21 percent to 25 percent. Respondents found the campaign materials helpful to physicians (81 percent in 2014 and 86 percent in 2017). However, that did not deter physicians from ordering unnecessary tests, with the most common justification identified in the 2017 survey being malpractice concerns (87 percent of respondents). “The discrepancy between the proportion of physicians who report that defensive medicine is a barrier to reducing the use of low-value care and empirical research that finds little evidence of the practice of defensive medicine deserves further investigation,” the authors conclude. “Multifaceted interventions that reinforce the Choosing Wisely guidelines through personalized education, continued follow-up, and tailored feedback will be necessary to overcome the substantial perceived and real barriers to reducing the use of low-value care.”
The authors, Carrie Colla and Alexander Mainor, are affiliated with the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College.
This study was supported by the ABIM Foundation and Agency for Healthcare Research and Quality (AHRQ).
How To Fulfill The Promise In The Next 5 Years
In this analysis, the authors discuss the Choosing Wisely® campaign’s accomplishments over the past five years and summarize what steps could fulfill its promise. They take note of movement’s growth since its founding, with seventy new societies signing on, ; more than 400 recommendations issued, and a steady increase in the number of studies testing interventions to reduce low-value care (see the exhibit below).
Exhibit 1: Cumulative Numbers Of Choosing Wisely Participating Societies, recommendations, And Published Articles On Interventions To Reduce Low-Value Care, 2012–16
Source: Authors’ analysis of information from Daniel Wolfson (ABIM Foundation, personal communication, June 29, 2017) and Jennifer Maratt (University of Michigan and Veterans Affairs Ann Arbor Healthcare System, personal communication, July 24, 2017) and of data on articles from PubMed and the Web of Science.
To better implement Choosing Wisely recommendations, the authors suggest new interventions, such as more consistently targeting the drivers of different types of low-value service utilization. They also suggest that more rigorous study designs are needed, to better explicate interventions’ potential effects and reduce the use of low-value care. To make these ideas reality, the authors recommend incentivizing professional societies to collaborate on approaches, with the ABIM Foundation serving as the convener. “Patients facing high deductibles also have a stake in ensuring that they do not receive unneeded services,” they conclude. “Choosing Wisely has created a principal pathway through which patients and their doctors can discuss when health care services may not be needed…. Several important steps still remain to fulfill the promise of Choosing Wisely. It is now time to take those steps.”
The authors, Eve Kerr, Jeffrey Kullgren, and Sameer Saint, are affiliated with the Center for Clinical Management Research at the Veterans Affairs Ann Arbor Health System and with the University of Michigan, also in Ann Arbor.
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