Study focuses on reducing low-value medical services

Betsy Cliff photo

Healthcare systems should be optimistic that interventions designed to reduce unnecessary medical tests, treatments and procedures can produce meaningful results for their organizations, according to new research authored by SPH’s Betsy Cliff, PhD, assistant professor of health policy and administration, published in The Milbank Quarterly.

Choosing Wisely is an initiative of the ABIM Foundation, which aims to promote conversations between clinicians and patients by helping patients choose care that is supported by evidence, not duplicative, free from harm and truly necessary.  At the same time, the initiative aims to balance the historical risks of people with limited resources at risk of receiving less effective healthcare.

“The Impact of Choosing Wisely Interventions on Low-value Medical Services: A Systematic Review,”examined 131 published articles on Choosing Wisely’s impact between its inception in 2012 and June 2019. Researchers have found that active interventions (65%) were more likely to generate reductions in overuse than merely disseminating Choosing Wisely recommendations (13%). Among active interventions, those with multiple components (77%) were more successful than those with one component (47%).

Additional findings include:

  • Most of the studied Choosing Wisely interventions focused on changing the behavior of clinicians or operations of health care systems.
  • Interventions that were notable and described in the review were changes in order sets, clinical decision support, clinical champions, academic detailing, creation of clinical pathways and clinical feedback or report cards.
  • There is a need for high-quality studies that include active controls.
  • The impact of clinician-focused interventions appeared to be more pronounced than the impact of consumer-focused interventions.

Researchers suggest disseminating Choosing Wisely guidelines alone does little to reduce low-value care.

Choosing Wisely has been praised for involving multiple stakeholders, including specialty societies in developing recommendations to avoid unnecessary medical tests, treatments and procedures. The ABIM Foundation launched the initiative in 2012 to advance a national dialogue on these issues.

To date, the campaign has engaged more than 80 medical specialist organizations and produced over 600 recommendations to reduce over-utilized services and improve patient care.

Study co-authors include Anton L. V. Avanceña, School of Public Health, University of Michigan; Richard A. Hirth, School of Public Health, University of Michigan; and Shoo-Yih Daniel Lee, College of Health Professions, Virginia Commonwealth University.  Funding was provided by the ABIM Foundation.

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