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Some Changes Seen in Line With 'Choosing Wisely' Initiative

Posted on Sun, Oct 18, 2015
Some Changes Seen in Line With 'Choosing Wisely' Initiative

Declines in two of seven recommendations: imaging for headache, cardiac imaging for low-risk patients

Significant decreases in low-value services were seen in accordance with two of seven early "Choosing Wisely" recommendations, according to a study published online Oct. 12 in JAMA Internal Medicine.

Alan Rosenberg, M.D., from Anthem Inc. in Indianapolis, and colleagues used nationwide commercial health plan population-level data to quantify the frequency and trends of some of the early "Choosing Wisely" recommendations. They conducted a retrospective analysis of claims data from Anthem-affiliated health plan members. Seven low-value services were selected: imaging tests for uncomplicated headache; cardiac imaging without history of cardiac conditions; low back pain imaging without red-flag conditions; preoperative chest X-ray with unremarkable history and physical examination results; human papillomavirus testing for women younger than 30 years; antibiotic use for acute sinusitis; and prescription nonsteroidal anti-inflammatory drug (NSAID) use for hypertension, heart failure, or chronic kidney disease.

The researchers found that there were significant decreases in use of imaging for headache (14.9 to 13.4 percent) and cardiac imaging (10.8 to 9.7 percent). Increases were seen in NSAID use in select conditions (14.4 to 16.2 percent) and human papillomavirus testing (4.8 to 6 percent). The other recommendations did not change significantly.

"These results suggest that additional interventions are necessary for wider implementation of 'Choosing Wisely' recommendations," the authors write.

Several authors are employees of HealthCore, which is a wholly owned Anthem subsidiary; several authors are employees of Anthem. All authors have financial ties to Anthem, which provided research support.

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