Choosing Wisely for radiology: More than a conversation starter

When the Choosing Wisely campaign was launched in 2012, the stated goal of the initiative was to "spark conversation" about the necessity of certain frequently ordered tests and treatments.

In a commentary published in the New England Journal of Medicine in February, Nancy Morden, an associate professor at the Dartmouth Institute for Health Policy & Clinical Practice, and colleagues wrote that the creators of the campaign "carefully crafted a recommendation for 'conversation,' emphasizing individual patients' needs as the top priority, preserving the preeminence of physician judgment, patient choice, and the therapeutic dyad."

But, while the stated goal of the program was to kick-start this conversation about unnecessary testing, Morden and her fellow authors also pointed out that the true value of the initiative will be its ability to effectively reduce those services listed by each of the participating specialties.

Currently, we are seeing evidence that Choosing Wisely recommendations--many of which are related to radiology and medical imaging--are, indeed, having an impact.

One of the more high-profile examples is that found at Cedars-Sinai Medical Center in Los Angeles. In 2013 Cedars-Sinai embedded more than 120 Choosing Wisely recommendations into its electronic medical record so that an alert would fire when a clinician attempted to authorize one of the associated tests. The hospital has since been able to document a reduction in some of these targeted unnecessary services.

And just last week, as reported in this issue of FierceMedicalImaging, a study was presented at the annual meeting of the American Society for Radiation Oncology (ASTRO), in which researchers determined that the use of a shorter, more convenient, and less costly schedule of radiation therapy for early-stage breast cancer is having a clinical impact.

The alternate breast cancer therapy practice--called hypofractionation--was suggested by ASTRO in one of its first five Choosing Wisely recommendations; the study found that since ASTRO made the recommendation, the use of hypofractionation increased from 9.67 percent to 21.30 percent among eligible patients. Though the study comes out of a small sample, it still provides us with a look at how practice patterns may be changing due to Choosing Wisely.

It's clear that the participating societies such as the American College of Radiology and ASTRO believe the program will have a meaningful impact on efforts to increase healthcare quality, improve the patient experience and eliminate or reduce unnecessary testing. Consequently, they are refining or adding to their lists, much as ASTRO did recently in published a second Choosing Wisely list.

Choosing Wisely is still in its early days, but it seems to be making a difference. - Mike (@FierceHealthIT)