Choosing Wisely initiative improvements posed by authors

The specialty societies involved in the Choosing Wisely initiative can improve the effort by more clearly defining the types of wasteful care they hope to stop and by better explaining how they arrive at their recommendations, according to a research letter published in the April 9 issue of JAMA.

“As Choosing Wisely continues to grow, clarity on the evidentiary justifications for the lists will be crucial for the overall credibility of the campaign,” write authors Catherine Gliwa and Steven D. Pearson, MD, of the National Institutes of Health, Bethesda, Md.

In the initiative, the American Board of Internal Medicine (ABIM) Foundation asks specialty societies to create “top five” lists of medical services they believe provide no overall benefit to patients/residents in most situations. Among the participating organizations are AMDA—The Society for Post-Acute and Long Term Care Medicine, which released a list of tests to avoid in long-term care settings; the American Geriatrics Society (AGS), which released two lists of tests and treatments to carefully consider in seniors; the American Psychiatric Association, which released guidelines on antipsychotic drug use; and the American Academy of Hospice and Palliative Medicine (AAHPM), which released a list of things doctors and patients should question in the hospice setting.

The authors studied the lists submitted by 25 participating specialty societies as of August 2013, which included 135 services. They found that services included on the lists often were as effective as, but more expensive than or carrying greater risk, than other services. Societies’ second most common rationale for including a test or treatment on a list was that not enough evidence existed to evaluate its benefit beyond the established indications, frequency, intensity or dosage. The authors cited the AGS and AAHPM lists in their examples.

“Our data show that the issue of cost was almost always raised in the context of a service being judged as good as other options but more expensive,” the authors write. “We believe that specialty societies should seek greater opportunities to include within their Top 5 lists services that offer only small incremental benefits at much higher prices.”

The ABIM Foundation posted a response to the research letter on its website April 9. It previously had released comments related to a commentary published in JAMA Internal Medicine and an article published in the New England Journal of Medicine.

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