Reflecting on the First Five Years of Choosing Wisely

On October 24, Health Affairs hosted Choosing Wisely: Opportunities and Challenges in Curbing Medical Overuse, a half-day briefing in Washington, DC, that reflected on the first five years of the Choosing Wisely campaign. In conjunction with the event, the ABIM Foundation published Choosing Wisely: A Special Report on the First Five Years (pdf).

In his opening remarks, Health Affairs editor Alan Weil welcomed the group of nearly 250 researchers, clinicians, consumer advocates, educators, Choosing Wisely grantees, journalists and others in attendance. He was then joined by Richard J. Baron, MD, President and CEO of the ABIM Foundation; Susan R. Mende, Senior Program Officer for the Robert Wood Johnson Foundation; and Jessica Rich, Vice President for Consumer Policy Mobilization at Consumer Reports, for a conversation about Choosing Wisely.

Conversations about appropriate care have advanced the campaign during its initial five years, the participants agreed. These include conversations between patients and clinicians, among medical specialty society members and between communities.

Dr. Baron began by acknowledging how the campaign originated from ABIM Foundation’s focus on professionalism as a way to improve the health care system. “Choosing Wisely is the practical expression of the Foundation’s mission,” he said.

To discuss what the campaign has accomplished so far, representatives from Choosing Wisely Grantee projects—Eric Wei, MD, of Los Angeles County + USC Medical Center; Matt Handley, MD, of the Washington Health Alliance and Kellie Slate Vitcavage from Maine Quality Counts—shared some of their success stories about reducing pre-operative tests, imaging and inappropriate antibiotics prescribing.

Arthur Hong, MD, from the University of Texas Southwestern Medical Center addressed ongoing challenges of Choosing Wisely, noting that his research showed only minimal reductions in imaging for low-back pain.

The next session focused on recent research about Choosing Wisely and the future of the campaign.

• Costs of Care’s Neel Shah, MD, discussed the Health Affairs blog post he wrote with colleagues about making Choosing Wisely central to medical education;
• The Dartmouth Institute’s Alexander Mainor, JD, MPH, gave an overview of results from a physician survey, published in Health Affairs, which showed that awareness did not substantially increase about the campaign in recent years and talked about ways to reverse this trend;
• John Mafi, MD, UCLA, talked about his recent findings that health services that are low cost and high volume account for most of unnecessary health spending; and
• Eve Kerr, MD, MPH, University of Michigan School of Medicine, shared strategies on how Choosing Wisely can achieve more in the next five years.

Michael Chernew, PhD, of Harvard Medical School, and Daniel Wolfson, Executive Vice President and Chief Operating Officer of the ABIM Foundation, provided reflections at the end of the event. They also co-authored an article on professionalism and Choosing Wisely that was posted on the Health Affairs blog.

“We were honored that so many people joined us to discuss Choosing Wisely and share ideas for the next five years of the campaign,” said Wolfson. “The important research from Health Affairs indicates that we have made progress, but that we need to do more to engage patients, clinicians, health systems and medical educators in reducing low-value care. Work on the next phase of Choosing Wisely has already begun.”