What’s next for Choosing Wisely?

Dr. Diana Buist and Dr. Matt Handley

Dr. Buist helps set course for giving people needed care

A new report called Promoting the Appropriate Use of Health Care Services sets research and policy priorities for efforts to give Americans the care they need—no more, no less. Those efforts to reduce low-value care include the Choosing Wisely® initiative.

Diana Buist, PhD, MPH, a senior investigator at Group Health Research Institute, co-wrote the report with Megan Collado, a colleague at AcademyHealth, where Dr. Buist is also a senior scholar in residence. AcademyHealth is a leading national organization serving health services and policy research—supporting the development and use of rigorous, relevant and timely evidence to increase the quality, accessibility, and value of health care, to reduce disparities, and to improve health. AcademyHealth and the ABIM Foundation co-sponsored the report.

Research conclusions

Dr. Buist and Ms. Collado reviewed recent and ongoing projects, surveyed experts, held a moderated discussion, and concluded that research should:

• Use clear definitions of terms to be developed through a process with multiple stakeholders.
• Target tests and treatments with a high level of evidence that they cause physical and/or financial harm.
• Identify both direct and indirect cost implications of inappropriate care.
• Specify measurement’s purpose and how much precision is needed for action in policy and practice.

Dr. Buist's work in this area grew from Group Health Foundation funding the Group Health Partnership for Innovation's low-value care project, whose goal is to improve the value of care. She is working closely with Matt Handley, MD, Group Health’s associate medical director, quality & informatics; Robert Reid, MD, PhD, Group Health’s medical director of research translation; and Group Health Research Institute staffers Eva Chang, PhD; Roy Pardee, JD, MS; Sharon Fuller; and Gabrielle Gundersen, MPH. They are asking clinicians with Group Health Physicians to identify priority areas for measurement and intervention.

High costs, low outcomes

This work is important because, like too little health care, too much can also harm people’s health. And with the world’s highest costs but not the best outcomes, the United States needs to get more bang for our health care buck.

That’s why Consumer Reports, the ABIM (American Board of Internal Medicine) Foundation, and various medical specialty societies launched Choosing Wisely in 2012. This was the first time that U.S. specialty societies had banded together to address overuse of health care services. Each society—60 at last count—has listed recommendations for doctors and patients to question at least five tests and treatments that the evidence doesn’t support.

Choosing Wisely encourages clinicians, patients, and other health care stakeholders to have conversations about medical tests and procedures that may be unnecessary and even harmful.