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ABIMF reviews Choosing Wisely progress, cites need for data analysis

The American Board of Internal Medicine Foundation has released a report on the progress made since its Choosing Wisely campaign, developed in a partnership with Consumer Reports, was introduced in 2012.

According to the report in Academic Medicine, the “campaign has ‘softened the ground’ for conversations about waste and prepared the nation for more difficult conversations.” More than 50 specialty societies, including the American Psychiatric Association and the American Academy of Allergy, Asthma & Immunology, have reportedly developed at least 250 recommendations for treatment strategies and tests to avoid under certain circumstances.

Framing unnecessary tests as being wasteful is one of the reasons Choosing Wisely has been successful, according to the report. “Waste is disrespectful of patients’ time and money and puts them at unduly risk for harm,” the researchers wrote, saying waste is also an issue of quality and safety.

From the standpoint of a physician, the researchers said “professional values and responsibilities are a potent motivator” behind adopting the changes recommended.

Going forward, the researchers wrote that continuing to focus on changing the attitudes of physicians and patients will be more effective than attempting to change behavior, based on the idea that “culture trumps strategy” and that prior reforms failed to include cultural components and professional engagement between providers and consumers. A grant from the Robert Wood Johnson Foundation has been acquired to work on local and regional levels to increase awareness of the program recommendations through specialty societies.

The researchers wrote that evaluation and measurement of the program’s impact also is needed.

“Critics are concerned that we have not emphasized measurement enough and as a result cannot report that the campaign has successfully changed behaviors, which is correct. None of the organizations involved in the campaign … has the data or the resources to take on this task,” they wrote, but added health systems and other points of delivery may have the means and data to do so, and encouraged analysis.

Disclosure: Two of the three authors are ABIM members; one is a medical director for Consumer Reports Health.