Back in April 2012, I blogged about a new campaign launched by the American Board of Internal Medicine Foundation to highlight commonly used medical procedures that nine key U.S. physician specialty societies agreed should not be commonly done. Each of the nine societies, representing 374,000 U.S. physicians, came up with five recommendations, 45 in all. Click here for my previous post listing all 45 recommendations. The campaign is called Choosing Wisely and you can find its site by clicking here.
I did wonder at the time how effectively this worthy campaign would be promoted. Since then, sorry to say I have heard nothing about the Choosing Wisely campaign.
Today, the ABIM Foundation announced grants to 21 organizations across the nation to promote awareness and understanding of the Choosing Wisely campaign. In Massachusetts, the chosen partner is Massachusetts Health Quality Partners, a great organization focused on improving quality, the patient experience, and appropriate use of medical services. (Disclosure -- I served on the MHQP Board of Directors between 2003 and 2008.)
MHQP plans to use the new grant to:
- Work with MHQP's members including, employers, health plans, and MHQP's own Patient and Public Engagement Council, to raise awareness about tests, treatments, and procedures the specialty societies taking part in the Choosing Wisely campaign have identified for patients and physicians to question.
- Work with the Massachusetts Medical Society to engage regional specialty societies to support and disseminate specialty society lists within their membership.
- Integrate Choosing Wisely resources into the MHQP's statewide Practice Pattern Variation Analysis initiative, in order to engage physicians to have discussions about reducing unnecessary care.
This is a most worthwhile efforts, and I wish MHQP and all the grantees great success.
By the way, what are the recommendations on what not to do? Here are 12:
- Don't do imaging for low back pain within the first six weeks, unless red flags are present.
- Don't order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.
- Don't obtain imaging studies in patients with non-specific low back pain.
- Don't do imaging for uncomplicated headache.
- Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.
- Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.
- Do not repeat colonoscopy for at least five years for patients who have one or two small (< 1 cm) adenomatous polyps, without high- grade dysplasia, completely removed via a high-quality colonoscopy.
- Don't perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.
- Don't perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.
- Don't initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.
- Don't perform stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present.
- Don't perform cardiac imaging for patients who are at low risk.
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