Choosing Wisely campaign linked to modest reduction in low-value care
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A decrease was seen in the use of two low-value services after the launch of the Choosing Wisely campaign; however, increases were seen in the use of other analyzed low-value services, according to recently published data in JAMA Internal Medicine.
“The Choosing Wisely Campaign represents a physician-driven effort to create conversations between physicians and patients around overuse and waste…Reducing use of unnecessary medical procedures and treatments is a key component to controlling health care expenditures. As much as 30% of U.S. health care expenditures are for interventions with marginal clinical benefits for patients and unnecessary diagnostic procedures that may lead to inappropriate treatment or a cascade of additional tests or procedures,” the researchers wrote.
To assess early trends in the reduction of seven low-value services after the launch of the Choosing Wisely campaign in April 2012, researchers analyzed medical and pharmacy claims from Anthem-affiliated Blue Cross and Blue Shield health care plans for roughly 25 million patients.
Results demonstrated a decrease in use was seen in two services: Use of imaging for headaches decreased from 14.9% to 13.4% (P < .001) and cardiac imaging in patients without a history of cardiac conditions decreased from 10.8% to 9.7% (P < .001).
In contrast, use of prescription nonsteroidal anti-inflammatory drugs in patients with hypertension, heart failure or chronic kidney disease increased from 14.4% to 16.2%, and HPV testing in women aged younger than 30 years increased from 4.8% to 6% (P < .001 for both).
Among the other three assessed low-value services, low back pain imaging without red-flag conditions, preoperative chest X-rays with unremarkable history and physical exam results and antibiotic use for acute sinusitis, rates of use remained stable.
“The relatively small use changes suggest that additional interventions are necessary for wider implementation of Choosing Wisely recommendations in general practice. Some of the additional interventions needed include data feedback, physician communication training, systems interventions (eg, clinical decision support in electronic medical records), clinical scorecards, patient-focused strategies and financial incentives,” the researchers wrote.
In an accompanying editorial, Ralph Gonzales, MD, MSPH., and Adithya Cattamanchi, MD, MAS, of the University of California, San Francisco, noted that it is uncertain whether health care providers are widely aware of the Choosing Wisely campaigns existence.
“As we have described, frameworks exist to guide delivery systems and clinician groups in developing and testing strategies to facilitate reducing the ordering of low-value tests and treatments. Further efforts to compel delivery systems to commit to Choosing Wisely are needed to leverage the grassroots/front-line cultural shifts that the campaign has stimulated before the impact wanes,” Gonzales and Cattamanchi wrote.– by Casey Hower
Disclosures: Rosenberg reports being an employee and stockholder with Anthem. Please see the full study for all authors’ relevant financial disclosures.