title: Choosing wisely: the American College of Rheumatology's Top 5 list of things physicians and patients should question.
abstract: OBJECTIVE
  We sought to develop a list of 5 tests, treatments, or services commonly used in rheumatology practice whose necessity or value should be questioned and discussed by physicians and patients.
  
  
  METHODS
  We used a multistage process combining consensus methodology and literature reviews to arrive at the American College of Rheumatology's (ACR) Top 5 list. Rheumatologists from diverse practice settings generated items using the Delphi method. Items with high content agreement and perceived high prevalence advanced to a survey of ACR members, who comprise >90% of the US rheumatology workforce. To increase the response rate, a nested random sample of 390 rheumatologists received more intensive survey followup. The samples were combined and weighting procedures were applied to ensure generalizability. Items with high ratings underwent literature review. Final items were then selected and formulated by the task force.
  
  
  RESULTS
  One hundred five unique items were proposed and narrowed down to 22 items during the Delphi rounds. A total of 1,052 rheumatologists (17% of those contacted) participated in the member-wide survey, whereas 33% of those in the nested random sample participated; respondent characteristics were similar in both samples. Based on survey results and available scientific evidence, 5 items (relating to antinuclear antibodies, Lyme disease, magnetic resonance imaging, bone absorptiometry, and biologic therapy for rheumatoid arthritis) were selected for inclusion.
  
  
  CONCLUSIONS
  The ACR Top 5 list is intended to promote discussions between physicians and patients about health care practices in rheumatology whose use should be questioned and to assist rheumatologists in providing high-value care.
authors: Division of Rheumatology, University of California, San Francisco, Box 0920, San Francisco, CA 94143-0920, USA. jinoos.yazdany@ucsf.edu
authors: Jinoos
authors: J
authors: Yazdany
authors: Gabriela
authors: G
authors: Schmajuk
authors: Mark
authors: M
authors: Robbins
authors: David
authors: D
authors: Daikh
authors: Ashley
authors: A
authors: Beall
authors: Edward
authors: E
authors: Yelin
authors: Jennifer
authors: J
authors: Barton
authors: Adam
authors: A
authors: Carlson
authors: Mary
authors: M
authors: Margaretten
authors: Joann
authors: J
authors: Zell
authors: Lianne S
authors: LS
authors: Gensler
authors: Victoria
authors: V
authors: Kelly
authors: Kenneth
authors: K
authors: Saag
authors: Charles
authors: C
authors: King
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000628:therapy*; D001688:Biological Products / Q000627:therapeutic use; D002755:Choice Behavior; D003697:Delphi Technique; D003955:Diagnostic Tests, Routine / Q000592:standards; D005500:Follow-Up Studies; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D010358:Patient Participation / Q000379:methods; D010820:Physicians / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D012219:Rheumatology / Q000379:methods / Q000592:standards*; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products