The Impact of Choosing Wisely Interventions on Low‐Value Medical Services: A Systematic Review

Abstract

r Dissemination of Choosing Wisely guidelines alone is unlikely to reduce the use of low-value health services. r Interventions by health systems to implement Choosing Wisely guidelines can reduce the use of low-value services. r Multicomponent interventions targeting clinicians are currently the most effective types of interventions. Context: Choosing Wisely aims to reduce the use of unnecessary, low-value medical services through development of recommendations related to service utilization. Despite the creation and dissemination of these recommendations, evidence shows low-value services are still prevalent. This paper synthesizes literature on interventions designed to reduce medical care identified as low value by Choosing Wisely and evaluates which intervention characteristics are most effective. Methods: We searched peer-reviewed and gray literature from the inception of Choosing Wisely in 2012 through June 2019 to identify interventions in the United States motivated by or using Choosing Wisely recommendations.We also included studies measuring the impact of Choosing Wisely on its own, without interventions. We developed a coding guide and established coding agreement. We coded all included articles for types of services targeted, components of each intervention, results of the intervention, study type, and, where

What strategies are used by clinician champions to reduce low-value care?

“…This multi-strategy focus is consistent with previously published de-implementation frameworks and theories of behavior change that show how conversations can influence people to relinquish an established routine or behavior. 10 , 27 , 30 – 33 …”

“… 4 , 12 It is also consistent with the finding that clinician champions were never used alone, only in combination with other interventions in a recent systematic review of Choosing Wisely interventions. 27 Commonly used co-interventions included clinician education, clinician feedback, and clinical decision support, similar to the strategies used by the clinician champions in this study.…”

“…A recent systematic review on the impact of Choosing Wisely interventions concluded that multi-component interventions that target clinicians are most effective. 27 Clinician champions, someone who could advocate for change among their colleagues, were identified as a clinician-focused intervention in some of the studies reviewed.…”

Less Timely Initiation of Glucose-Lowering Medication Among Younger and Male Patients With Diabetes and Similar Initiation of Blood Pressure-Lowering Medication Across Age and Sex: Trends Between 2015 and 2020

“…The lack of lower thresholds for the youngest age group and higher thresholds for the oldest age group at initiation of glucose- and blood pressure-lowering drugs calls for interventions to support age-related personalized diabetes treatment. Multicomponent interventions targeting clinicians are seen as effective type of interventions ( Harvey and Kitson, 2015 ; Cliff et al, 2021 ). This could include educational programs, implementation of decision support tools with specific alerts, feedback reports and other health system interventions.…”

“…Currently, it is unknown to what extent have these changes in treatment recommendations been applied in clinical practice. It is known that dissemination of new recommendations may need additional interventions targeting clinicians to be effective at changing practice patterns ( Cliff et al, 2021 ).…”