Study Assesses Trends Based on Choosing Wisely Campaign Recommendations
Finds Significant Decline in Cardiac Imaging in Low-Risk Patients

There has been a decrease in the use of cardiac imaging for low-risk patients – one of the ABIM Foundation’s Choosing Wisely campaign’s recommendations – according to a study published Oct. 12 in JAMA Internal Medicine.

Alan Rosenberg, MD, et al., looked at claims data for members of Anthem-affiliated commercial health plans, and assessed the frequency and trends of seven low-value services included in the 2012 Choosing Wisely campaign recommendations. Results showed that cardiac imaging decreased from 10.8 percent to 9.7 percent (trend estimate, 0.99 [95 percent CI, 0.99-0.99]; P<0.001). In addition, use of imaging for headache decreased, while the use of nonsteroidal anti-inflammatory drugs in select conditions and human papillomavirus testing in younger women increased.

The authors note that their results “suggest that additional interventions are necessary for wider implantation of Choosing Wisely recommendations.” They add that some of the additional interventions needed include “data feedback, physician communication training, systems interventions, clinician scorecards, patient-focused strategies, and financial incentives.”

In a related commentary, Ralph Gonzales, MD, MSPH, and Adithya Cattamanchi, MD, MAS, write that, “further efforts to compel delivery systems to commit to Choosing Wisely are needed to leverage the grassroots/front-line cultural shifts that the campaign has stimulated before the impact wanes.”

In a related viewpoint, David H. Howard, PhD, and Cary P. Gross, MD, note, “A comprehensive initiative to fund trials comparing established medical treatments with less costly alternatives should complement ongoing efforts to reduce low-value care through physicians stewardship and innovations in health care. There is a need for evidence that will guide decisions about clinical care. Instead of asking, ‘Does evidence affect practice?’ we ought to be asking, ‘How can we produce more of it?’”

“In 2005 the ACC began the process of convening several medical society partners to develop Appropriate Use Criteria (AUC) for cardiac imaging and cardiac procedures,” said Kim Allan Williams Sr., MD, FACC, president of the ACC. “In some areas, such as nuclear perfusion imaging (the first published AUC), the reduction of overall use was dramatic, with marked annual utilization declines since 2006, paralleling our efforts to identify and curb inappropriate use.”

"We proposed these established AUC principles to the Choosing Wisely campaign in 2012, recognizing that further education and reaching a broader audience could further our goal of the 'right test for the right patient at the right time.' We are pleased to see these results inside and outside of cardiology, and expect that our ACC AUC and Choosing Wisely recommendations will continue the decline in inappropriate use of cardiac testing and treatments.

Clinical Topics: Noninvasive Imaging

Keywords: Diagnostic Imaging, Internal Medicine

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