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Choosing Wisely: setbacks and progress

BMJ 2015; 351 doi: (Published 15 December 2015) Cite this as: BMJ 2015;351:h6760

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In response to "Choosing Wisely: setbacks and progress"

The article “Choosing Wisely: setbacks and progress” articulates a number of successes and challenges the campaign has experienced since its creation. Choosing Wisely—like any ambitious effort—is not without areas that could be improved. But on the whole we believe there are many successes to celebrate and are optimistic about its future.

We launched Choosing Wisely in 2012 with a goal of sparking conversations between clinicians and patients about avoiding unnecessary care, and we’ve been heartened by the continued leadership and collaboration from the profession in addressing overuse and waste. This year 17 medical specialty societies published 80 new Choosing Wisely recommendations, bringing the collective total to nearly 450. Two societies—the American Academy of Neurology (AAN) and the American Society of Hematology (ASH)—significantly expanded the scope of their work to identify and publicize recommendations from other societies relevant to their respective specialties. AAN published a journal article that identified 74 recommendations that neurologists should be aware of; ASH identified five recommendations from other society lists and featured them during a learning session at their annual meeting in December 2015.

While Choosing Wisely is focused on fostering conversations about unnecessary care, we know many are interested in how systems can implement the campaign and put its ideals in practice. In mid-2015 the ABIM Foundation, with support from the Robert Wood Johnson Foundation, announced funding for seven new initiatives aimed at reducing the utilization of at least three tests or treatments that our Choosing Wisely society partners have said are overused—including the use of antibiotics for viral infections—by 20 percent over nearly three years at participating health systems, hospitals and medical groups in their regions. These groups, along with former grantees and other interested institutions, are part of a Choosing Wisely Learning Network that shares information and best practices about what is working and ways to overcome shared challenges of reducing unneeded care.

In some areas the seeds of early implementation efforts are already beginning to bear fruit. For example, at Crystal Run Healthcare in New York, staff worked to embed four Choosing Wisely recommendations from the American Academy of Family Physicians (AAFP) in its EMR system. When a physician would attempt to order a test or treatment from AAFP an alert would pop up that included a set of questions designed to raise awareness of their appropriateness. The project resulted in utilization decreases for annual EKGs, MRIs for low back pain, and DEXA screening. This is just one of several implementation stories we have shared through our monthly newsletter.

And the ABIM Foundation is far from the only one writing about Choosing Wisely. Articles about the campaign and overuse in health care appear almost daily in scholarly publications and the mainstream media. More than 300 journal articles have been published about Choosing Wisely and the society recommendations since 2012. Thousands of stories have run in outlets such as the New York Times, Washington Post, USA Today and the Wall Street Journal.

It’s important to remember the Choosing Wisely campaign is still a young effort, and will require more time before its ideals can fully take root and implementation efforts proliferate. But considering that it was just a few short years ago that we launched Choosing Wisely with nine medical specialty societies and Consumer Reports, we have been pleased to see how the campaign has grown into one of the most widely-recognized efforts to advance conversations aimed at reducing waste and overuse in health care.

Competing interests: No competing interests

18 December 2015
Daniel B Wolfson
ABIM Foundation
510 Walnut Street. Suite 1700, Philadelphia, PA 19106