Choosing Wisely

Choosing Wisely
Name	Choosing Wisely
Formation	2012
Type	Health campaign
Headquarters	United States
Leader title	Leadership

Choosing Wisely

Choosing Wisely is a clinician-led health campaign that promotes conversations about avoiding unnecessary medical tests, treatments, and procedures. The initiative engages professional societies, hospitals, and patient groups to produce evidence-informed recommendations intended to reduce low-value care. It intersects with health policy, quality improvement, and patient advocacy efforts across multiple health systems.

Overview

Choosing Wisely was launched to address overuse and promote shared decision-making among clinicians and patients. Major supporters include the American Board of Internal Medicine, Robert Wood Johnson Foundation, Institute of Medicine, Agency for Healthcare Research and Quality, and numerous specialty societies such as the American College of Physicians, American Academy of Pediatrics, and American College of Cardiology. The campaign emphasizes stewardship of resources alongside clinical safety, aligning with initiatives by World Health Organization, Centers for Medicare & Medicaid Services, and professional regulators like the Federation of State Medical Boards. Patient-facing organizations such as Consumer Reports and National Patient Safety Foundation have partnered to translate recommendations into actionable conversations.

History and Development

Choosing Wisely was initiated in 2012 following convenings involving the American Board of Internal Medicine Foundation, the ABIM Foundation, and leaders from specialty societies including the American College of Radiology and American Society of Clinical Oncology. Early momentum drew on reports from the Institute of Medicine on waste in healthcare and policy discussions in the U.S. Congress and White House. Internationally, policy dialogues with the National Health Service (England), Canadian Institutes of Health Research, and organizations in Australia and Germany influenced adaptation. Funding and convening partners included philanthropic organizations like the Robert Wood Johnson Foundation and academic centers such as Harvard Medical School and Johns Hopkins University, which contributed research, measurement, and dissemination expertise.

Recommendations and Campaign Structure

Recommendations are produced by specialty societies and framed as "Five Things Physicians and Patients Should Question" lists. Contributing organizations include the American College of Surgeons, American Academy of Family Physicians, American Psychiatric Association, American Gastroenterological Association, and American Society of Nephrology. Each list cites evidence from trials published in journals such as the New England Journal of Medicine, JAMA, and The Lancet. The campaign uses tools from the National Quality Forum and measurement guidance from the Agency for Healthcare Research and Quality for selecting metrics. Patient communication materials have been developed in collaboration with Healthwise and patient advocacy groups including PatientsLikeMe and the National Partnership for Women & Families.

Implementation and Impact

Hospitals, health systems, and payers have adopted Choosing Wisely recommendations in quality programs operated by organizations such as Mayo Clinic, Cleveland Clinic, Kaiser Permanente, and Veterans Health Administration. Measurement efforts have linked lists to claims-based analyses by Centers for Medicare & Medicaid Services and research by universities like University of Michigan and Stanford University. Reported impacts include reductions in certain imaging orders and laboratory tests, with implementation strategies informed by Institute for Healthcare Improvement methods and implementation science from National Institutes of Health networks. Payor initiatives and value-based payment models from Medicare and private insurers have sometimes incorporated low-value care metrics influenced by the campaign.

Criticism and Controversies

Choosing Wisely has faced critiques regarding evidence bases, unintended consequences, and measurement approaches. Scholars from Harvard School of Public Health, Johns Hopkins Bloomberg School of Public Health, and Yale School of Medicine have debated whether lists adequately capture clinical nuance or risk underuse. Debates in forums such as Health Affairs and at conferences hosted by Society of General Internal Medicine and AcademyHealth have highlighted concerns about pay-for-performance linkage, potential for cost-cutting over patient-centered care, and medico-legal implications raised by organizations like the American Medical Association and state medical boards. Investigations by think tanks including the Brookings Institution and critiques from consumer groups such as Public Citizen have also shaped discourse.

International and Specialty-Specific Initiatives

The Choosing Wisely model has been adapted by national campaigns including Choosing Wisely Canada, Choosing Wisely Australia, and initiatives coordinated with the World Health Organization and the European Observatory on Health Systems and Policies. Specialty-specific extensions have been produced by the American College of Rheumatology, American Society of Hematology, American College of Emergency Physicians, American Academy of Neurology, and Society of Thoracic Surgeons. Collaborations with multicenter research consortia such as PCORI and guideline bodies like the National Institute for Health and Care Excellence have supported local adaptation and research on effectiveness.

Category:Health campaigns Category:Medical ethics