The “Top 12” Recommendations That Are Reducing Overuse

ABIM Foundation staff identified a “Top 12” list of Choosing Wisely recommendations that drove the largest decrease in unnecessary tests and procedures. This list was created using an analysis of reports created by the incremental cost-effectiveness ratio (ICER) and successful implementation projects gathered through grantee metrics, peer-reviewed journals and an informal environmental scan of implementation within the Choosing Wisely learning network. Sources included 18 peer-reviewed journals, 14 health systems and 34 self-reported results from learning network members. Success was defined as a 10 percent decrease in unnecessary tests or procedures. Analysis by ICER and implementation published in peer-reviewed journals was weighted.

The Choosing Wisely “Top 12” include:

1. Use of antibiotics in patients with upper respiratory infections – Based on recommendations from American Academy of Allergy, Asthma, & Immunology, American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians and Infectious Diseases Society of America

2. Imaging for nonspecific low back pain – Based on recommendations from American Academy of Family Physicians, American Association of Neurological Surgeons and Congress of Neurological Surgeons, American Chiropractic Association, American College of Emergency Physicians, American College of Physicians, American Society of Anesthesiologists-Pain Management and North American Spine Society

3. Imaging for uncomplicated or stable headaches – Based on recommendations from American College of Radiology

4. Vitamin-D testing – Based on recommendations from American Academy of Pediatrics, American Society for Clinical Pathology and Endocrine Society

5. Repetitive CBC and labs –Based on recommendations from Critical Care Societies Collaborative and Society of Hospital Medicine            

6. In-patient blood utilization – Based on recommendations from AABB, American College of Obstetricians and Gynecologists, American Society of Anesthesiologists, American Society of Hematology, Critical Care Societies Collaborative and Society of Hospital Medicine

7. Routine annual cervical cytology screening (Pap tests) – Based on recommendations from American College of Obstetricians and Gynecologists and American Society for Colposcopy and Cervical Pathology

8. Benzodiazepines for adults 65 years of age and older – Based on recommendations from American Academy of Nursing  and American Geriatrics Society

9. Preoperative testing in patients scheduled to undergo low- and/or intermediate-risk non-cardiac surgery – Based on recommendations from American Academy of Ophthalmology, American College of Physicians, American College of Radiology, American College of Surgeons, American Society of Anesthesiologists, American Society for Clinical Pathology, American Society of Echocardiography and Society of Thoracic Surgeons

10. Telemetry in non-intensive care unit – Based on recommendations from Society of Hospital Medicine

11. Antibiotics beyond 72 hours for inpatients with no signs of infection – Based on recommendations from Society for Healthcare Epidemiology of America 

12. DEXA scans – Based on recommendations from American Academy of Family Physicians and American College of Rheumatology)

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READ MORE:

• Choosing Wisely at the Right Time
• Helping Patients Take Care of Themselves