Choosing Wisely continues to inform quality improvement initiatives and implementation projects in a variety of settings, adding to the growing body of scholarship that focuses on unnecessary medical services and low-value care. Here are a handful of the ABIM Foundation’s picks for the best journal articles of last year.
- Chen D, Bhambhvani HP, Hom J, Mahoney M, Wintermark M, Sharp C, Ratliff J, Yi-Ren C. Effect of Electronic Clinical Decision Support on Imaging for the Evaluation of Acute Low Back Pain in the Ambulatory Care Setting. World Neurology. November 2019This study demonstrates the effectiveness of a simple, low-cost clinical decision support tool in reducing imaging rates for patients with acute low back pain, and identifies reasons why clinicians order imaging outside of clinical guidelines.
- Ganguli I, Simpkin AL, Lupo C, Weissman A, Mainor AJ, Orav J, Rosenthal MB, Colla CH, Sequist TD. Cascades of Care After Incidental Findings in a U.S. National Survey of Physicians. JAMA. October 2019This survey, the first of its kind, examines physician perceptions and experiences of cascading tests and treatments nationally. Incidental findings on screening and diagnostic tests are common and may prompt cascades of testing and treatment that are of uncertain value. The survey findings indicate that almost all respondents had experienced cascades after incidental findings that did not lead to clinically meaningful outcomes yet caused harm to patients and themselves.
- Shrank WH, Rogstad TL, Parekh N. Waste in the US Health Care System – Estimated Costs and Potential for Savings. JAMA. October 2019Based on six domains of health care waste, this review estimated that the cost of waste in the U.S. health care system ranged from $760 billion to $935 billion, accounting for approximately 25% of total health care spending. Projected potential savings from interventions that reduce waste, excluding savings from administrative complexity, ranged from $191 billion to $282 billion, representing a potential 25% reduction in the total cost of waste. Implementation of effective measures to eliminate waste represents an opportunity to reduce the continued increases in U.S. health care expenditures, the study said.
- Rubins D, Boxer R, Landman A, Wright A. Effect of default order set settings on telemetry ordering. Journal of the American Medical Informatics Association. September 2019This retrospective, controlled, before-after study looked at telemetry orders for patients admitted to a house staff medicine service at an academic medical center. It examined the effect on ordering behavior of changing whether the telemetry order was pre-selected or not, and showed that default selections in electronic health record order sets can have significant consequences on ordering behavior.
- Molloy MJ, Tamaroff J, McDaniel L, Genies MC. Targeted Education Across Clinical Settings Improves Adherence to Evidence-Based Interventions for Bronchiolitis. Clinical Pediatrics. June 2019This study involves a pre-post educational intervention designed to improve adherence to bronchiolitis guidelines in the emergency department (ED) and inpatient settings. Among children meeting inclusion criteria, ED bronchodilator use and steroid use decreased significantly, but there was no difference in viral testing, antibiotic use or chest radiography. No differences occurred in the inpatient setting. The study determined that targeted education across settings contributed to reducing bronchodilator use in the ED.