Dheeraj Mahajan, MD, CMD, has been named a 2018 Choosing Wisely Champion by
AMDA—The Society for Post-Acute and Long-Term Care Medicine. The award honors
individual clinicians and teams of clinicians who have gone above and beyond to make
significant contributions to advance the ideals of the ABIM Foundation’s Choosing Wisely campaign by working to reduce unnecessary tests, treatments and procedures in health care.
Launched in 2012 by the ABIM Foundation, Choosing Wisely is widely recognized across the
health care system as a leading effort to reduce overuse and waste in medicine. More than 80
medical specialty societies, including AMDA, have joined the campaign and published over 550
recommendations regarding overused or unnecessary care.
“The Choosing Wisely campaign is critical, and we are pleased that our members are using this
resource in their efforts to advance quality care,” says Society President Cari Levy, MD, PhD,
CMD. “In an environment where we are faced with so much information, the Choosing Wisely
lists help focus our attention on issues we agree are important to our patients. I often look at
issues identified by other specialties and hope they do the same with ours.”
Dr. Mahajan’s initiative was designed to reduce the incidence of urinary tract infection (UTI) in
nursing home patients transferred to emergency departments. “While urinary tract infections are
monitored and tracked in long-term care facilities, little work has been done in emergency
departments,” said Dr. Mahajan, President and CEO of Chicago Internal Medicine Practice and
Along with geriatrics fellows from Loyola University and Edward Hines Jr. VA Hospital, Dr.
Mahajan analyzed emergency department transfers in the last year through retrospective chart
reviews for patients from skilled nursing facilities sent out to the closest ED.
Of 20 patients transferred, 13 had urine analysis performed. Over 60 percent of patients who
received the urine analysis had no clear indications for the test and those who were diagnosed
with a UTI were all given antibiotics.
“With this information, we have initiated an education program geared toward emergency
department providers to review the appropriate indications for ordering a urinalysis and culture.
After the interventions, we found an immediate significant drop in the incidence of urinary tract
infection diagnosis in patients returning from ED,” said Dr. Mahajan. The intervention and
education occurred in late February 2018, and his team is planning to finalize three months of
data to perform a formal statistical analysis. Having the Choosing Wisely recommendation on
this issue—”Don’t obtain a urine culture unless there are clear signs and symptoms that localize
to the urinary tract”—and the clinical evidence and support of experts behind it were significant,
Dr. Mahajan said. “To have specialty societies such as AMDA backing up the data on this was
very helpful and much more powerful than me just quoting an article from the literature.”
Dr. Mahajan was honored but surprised to receive the award. “I had stepped out of the room to
say good morning to my children back home, so I missed the announcement. I started getting
congratulatory messages and was pleasantly surprised.” He and his team, he said, are honored to
be recognized and proud of what they were able to accomplish.
For more information about Choosing Wisely and the Choosing Wisely Champions awards
program visit www.choosingwisely.org.
About the Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical
specialty society representing the community of over 50,000 medical directors, physicians, nurse
practitioners, physician assistants, and other practitioners working in the various post-acute and
long-term care (PA/LTC) settings. Dedicated to defining and improving quality, we advance our
mission through timely professional development, evidence-based clinical guidance, and tireless
advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more
About ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the
health care system. This is achieved by collaborating with physicians and physician leaders,
medical trainees, health care delivery systems, payers, policy makers, consumer organizations
and patients to foster a shared understanding of professionalism and how they can adopt the
tenets of professionalism in practice. To learn more about the ABIM Foundation,
visit www.abimfoundation.org, connect on Facebook or follow on Twitter.
About Choosing Wisely
First announced in December 2011, Choosing Wisely is part of a multi-year effort led by the
ABIM Foundation to support and engage physicians in being better stewards of finite health care
resources. Participating specialty societies are working with the ABIM Foundation to share the
lists widely with their members and convene discussions about the physician’s role in helping
patients make wise choices. Learn more at www.ChoosingWisely.org.