Study tracking Choosing Wisely impact finds mixed results for low-value imaging

A study evaluating Choosing Wisely’s impact on use of four different low-value imaging services noted a significant decrease in two of them, with little to no impact in the other two, according to findings published by JAMA Internal Medicine. 

Abiy Agiro, PhD, of HealthCore Inc in Wilmington, Del., and colleagues conducted the study, assessing whether use of certain low-value services in a variety of specialties occurred more or less frequently as a result of the Choosing Wisely campaign.

The team noted in its study that the societies involved in Choosing Wisely don’t always focus on reducing the same services.

Preoperative chest x-rays were listed by the American College of Radiology (ACR) and American College of Physicians, for instance, while imaging for headaches was only listed by the ACR.

“The rationale for including specific services in the Choosing Wisely lists varied, although most services selected typically yield a low level of clinically relevant information,” the authors wrote.

The four evaluated imaging services were: imaging tests for headaches with uncomplicated conditions, cardiac imaging for members without a history of cardiac conditions, preoperative chest x-rays with unremarkable history and exam results, and low back pain imaging for members without red flags.  

The team found that imaging for headaches decreased from 14.9 percent to 13.4 percent, a relative reduction of more than 10 percent, and cardiac imaging decreased from 10.8 percent to 9.7 percent, also a relative reduction of more than 10 percent.

Use of preoperative chest x-rays and low back pain imaging, however, remained almost exactly the same, with no significant change in either direction.

Overall, Agiro et al. concluded that more could be done to increase the impact of the Choosing Wisely campaign, providing some specific examples for those in the industry to consider.  

“Our population- level analysis showed both desirable and undesirable modest trends in use of low-value services,” the authors wrote. “The relatively small use changes suggest that additional interventions are necessary for wider implementation of Choosing Wisely recommendations in general practice. Some of the additional interventions needed include data feedback, physician communication training, systems interventions (eg, clinical decision support in electronic medical records), clinician scorecards, patient focused strategies, and financial incentives.”