Choosing Wisely: ABIM asked professional societies how best to eliminate high-cost/low value care. Consumer Reports got on board and the result was this. See the link to the lists from each society with the rationale for each. Below is the full list.
Choosing Wisely
1. Don’t perform unproven diagnostic tests, such as
immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E
(IgE) tests, in the evaluation of allergy.
2. Don’t order sinus computed tomography (CT) or
indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
3. Don’t routinely do diagnostic testing in patients with
chronic urticaria.
4. Don’t recommend replacement immunoglobulin therapy for
recurrent infections unless impaired antibody responses to vaccinesare
demonstrated.
5. Don’t diagnose or manage asthma without spirometry.
6. Don’t do imaging for low back pain
within the first six weeks, unless red flags are present.
7. Don’t routinely prescribe
antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven
or more days, or symptoms worsen after initial clinical improvement.
8. Don’t use dual-energy x-ray
absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or
men younger than 70 with no risk factors.
9. Don’t order annual
electrocardiograms (EKGs) or any other cardiac screening for low-risk patients
without symptoms.
10. Don’t perform Pap smears on women
younger than 21 or who have had a hysterectomy for non-cancer disease.
11. Don’t perform stress cardiac
imaging or advanced non-invasive imaging in the initial evaluation of patients
without cardiac symptoms unless high-risk markers are present.
12. Don’t perform annual stress cardiac
imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic
patients.
13. Don’t perform stress cardiac
imaging or advanced non-invasive imaging as a pre-operative assessment in
patients scheduled to undergo low-risk non-cardiac surgery.
14. Don’t perform echocardiography as
routine follow-up for mild, asymptomatic native valve disease in adult patients
with no change in signs or symptoms.
15. Don’t perform stenting of
non-culprit lesions during percutaneous coronary intervention (PCI) for
uncomplicated hemodynamically stable ST-segment elevation myocardial infarction
(STEMI).
16. Don’t obtain screening exercise
electrocardiogram testing in individuals who are asymptomatic and at low risk
for coronary heart disease.
17. Don’t obtain imaging studies in
patients with non-specific low back pain.
18. In the evaluation of simple syncope
and a normal neurological examination, don’t obtain brain imaging studies (CT
or MRI).
19. In patients with low pretest
probability of venous thromboembolism (VTE), obtain a high-sensitive D-dimer
measurement as the initial diagnostic test; don’t obtain imaging studies as the
initial diagnostic test.
20. Don’t obtain preoperative chest
radiography in the absence of a clinical suspicion for intrathoracic pathology.
21. Don’t do imaging for uncomplicated headache.
22. Don’t image for suspected pulmonary
embolism (PE) without moderate or high pre-test probability.
23. Avoid admission or preoperative
chest x-rays for ambulatory patients with unremarkable history and physical
exam.
24. Don’t do computed tomography (CT)
for the evaluation of suspected appendicitis in children until after ultrasound
has been considered as an option.
25. Don’t recommend follow-up imaging
for clinically inconsequential adnexal cysts.
26. For pharmacological treatment of
patients with gastroesophageal reflux disease (GERD), long-term acid
suppression therapy (proton pump inhibitors or histamine2 receptor antagonists)
should be titrated to the lowest effective dose needed to achieve therapeutic
goals.
27. Do not repeat colorectal cancer
screening (by any method) for 10 years after a high-quality colonoscopy is
negative in average-risk individuals.
28. 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.
29. For a patient who is diagnosed with
Barrett’s esophagus, who has undergone a second endoscopy that confirms the
absence of dysplasia on biopsy, a follow-up surveillance examination should not
be performed in less than three years as per published guidelines.
30. For a patient with functional
abdominal pain syndrome (as per ROME
III criteria) computed tomography (CT) scans should not be repeated unless
there is a major change in clinical findings or symptoms.
31. Don’t use cancer-directed therapy
for solid tumor patients with the following characteristics: low performance
status (3 or 4), no benefit from prior evidence-based interventions, not eligible
for a clinical trial, and no strong evidence supporting the clinical value of
further anti-cancer treatment.
32. Don’t perform PET, CT, and
radionuclide bone scans in the staging of early prostate cancer at low risk for
metastasis.
33. Don’t perform PET, CT, and
radionuclide bone scans in the staging of early breast cancer at low risk for
metastasis.
34. Don’t perform surveillance testing
(biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic
individuals who have been treated for breast cancer with curative intent.
35. Don’t use white cell stimulating
factors for primary prevention of febrile neutropenia for patients with less
than 20 percent risk for this complication.
36. Don’t perform routine cancer
screening for dialysis patients with limited life expectancies without signs or
symptoms.
37. Don’t administer
erythropoiesis-stimulating agents (ESAs) to chronic kidney disease (CKD)
patients with hemoglobin levels greater than or equal to 10 g/dL without
symptoms of anemia.
38. Avoid nonsteroidal
anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart
failure or CKD of all causes, including diabetes.
39. Don’t place peripherally inserted
central catheters (PICC) in stage III–V CKD patients without consulting
nephrology.
40. Don’t initiate chronic dialysis
without ensuring a shared decision-making process between patients, their
families, and their physicians.
41. Don’t perform stress cardiac
imaging or coronary angiography in patients without cardiac symptoms unless
high-risk markersare present.
42. Don’t perform cardiac imaging for
patients who are at low risk.
43. Don’t perform radionuclide imaging
as part of routine follow-up in asymptomatic patients.
44. Don’t perform cardiac imaging as a
pre-operative assessment in patients scheduled to undergo low- or
intermediate-risknon-cardiac surgery.
45. Use methods to reduce radiation
exposure in cardiac imaging, whenever possible, including not performing such
tests when limited benefits are likely.
