Choosing Wisely Campaigns

Abstract

Choosing Wisely, a campaign to stimulate conversations between physicians and patients about unnecessary tests, treatments, and procedures, began in the United States in 2012. It was designed as a national campaign about overuse. Yet since its launch, the campaign has spread to more than 20 countries worldwide. Choosing Wisely has been hailed by some as a success, evident in its spread internationally and measured through structure and process indicators, such as recommendations developed, societies engaged, and physicians apprised. The conversation has been stimulated, and now delivery systems and clinical practices are beginning to develop interventions that go beyond conversations and recommendations. The success of the campaign in the next 5 years will be measured by the ongoing engagement of physicians in these interventions and, more importantly, associated outcomes. The effectiveness of quality improvement efforts by these delivery systems will determine how influential campaigns are in actually reducing unnecessary tests and treatments-a true measure of benefit. 1 The concepts of diffusion of innovation are relevant to understanding the success to date of Choosing Wisely campaigns and to informing strategies that would ensure future viability. This Viewpoint uses diffusion of innovation science to explore factors that facilitated the spread of Choosing Wisely campaigns and how these enabling factors can address challenges in dissemination and implementation.There are various examples of movements to shift medical culture that had early momentum and resulted in significant changes but were met with major challenges around influence and outcomes. Nearly 2 "Reinvention" of the Innovation Research demonstrates higher uptake if users can adapt or "reinvent" innovations to their own setting.Choosing Wisely focuses on conversations between physicians and patients, the basis of clinical interactions.

Reducing overuse in healthcare: advancing Choosing Wisely

“…A key part of Choosing Wisely has been specialty societies putting together lists of recommendations to disseminate among their peers 5. Societies have autonomy to do this independently, resulting in considerable heterogeneity in scope.…”

Choosing Wisely campaigns globally: A shared approach to tackling the problem of overuse in healthcare

“…The approach of clinician leadership and professionalism as a means to address the problem of overuse has resonated. It is suggested that the campaign has spread widely because of (a) the perceptions of the campaign as an innovation within medicine; (b) the role of physician leadership as key component of campaigns; and (c) the context of campaigns bringing together diverse stakeholders committed to a common problem …”

De-implementing wisely: developing the evidence base to reduce low-value care

“…Similar efforts have been planned or launched in Germany, Austria, Australia, New Zealand, England, Wales, Italy, Netherlands, Norway, Portugal, France, Israel, Brazil and Japan with other countries planning or in early stages of launching national campaigns. Internationally, CW leaders from existing or planned national CW campaigns meet yearly to discuss implementation of the recommendations in their respective countries and collectively have formed a collaborative learning community 13…”