title: Early Trends Among Seven Recommendations From the Choosing Wisely Campaign.
abstract: OBJECTIVE
  The Choosing Wisely campaign consists of more than 70 lists produced by specialty societies of medical practices or procedures of minimal clinical benefit to patients in most situations, with recommendations regarding judicious use.
  
  
  OBJECTIVE
  To quantify the frequency and trends of some of the earliest Choosing Wisely recommendations using nationwide commercial health plan population-level data.
  
  
  METHODS
  Retrospective analysis of claims data for members of Anthem-affiliated commercial health plans. The low-value services selected were (1) imaging tests for uncomplicated headache; (2) cardiac imaging without history of cardiac conditions; (3) low back pain imaging without red-flag conditions; (4) preoperative chest x-rays with unremarkable history and physical examination results; (5) human papillomavirus testing for women younger than 30 years; (6) use of antibiotics for acute sinusitis; and (7) use of prescription nonsteroidal anti-inflammatory drugs (NSAIDs) for members with hypertension, heart failure, or chronic kidney disease.
  
  
  METHODS
  The number of members with medical and/or pharmacy claims for the included low-value services was assessed quarterly over a 2- to 3-year span through 2013. Trend changes in recommendations were evaluated across all quarters using Poisson regression with denominators as offsets.
  
  
  RESULTS
  Two services had declines: Use of imaging for headache decreased from 14.9% to 13.4% (trend estimate, 0.99 [95% CI, 0.98-0.99]; P < .001), and cardiac imaging decreased from 10.8% to 9.7% (trend estimate, 0.99 [95% CI, 0.99-0.99]; P < .001). Two services had increases: Use of NSAIDs in select conditions increased from 14.4% to 16.2% (trend estimate, 1.02 [95% CI, 1.01-1.02]; P < .001), and human papillomavirus testing in younger women increased from 4.8% to 6.0% (trend estimate, 1.01 [95% CI, 1.00-1.01]; P < .001). Use of antibiotics for sinusitis remained stable (0.8% decrease from 84.5% to 83.7%; trend estimate, 1.00 [95% CI, 1.00-1.00]; P = .16). Use of preoperative chest x-rays (0.2% decrease, ending utilization 91.5%; trend estimate, 1.00 [95% CI, 1.00-1.00]; P = .70) and imaging for low back pain (53.7% utilization throughout study; P = .71) remained high with no statistically significant changes.
  
  
  CONCLUSIONS
  For this population-level analysis of 7 low-value services analyzed, changes were modest but showed a desirable decrease for 2 recommendations (imaging for headache, cardiac imaging for low-risk patients). The effect sizes were marginal, however, and although 4 of the 7 lists had statistically significant changes-unsurprising given the large sample size-the clinical significance is uncertain. These results suggest that additional interventions are necessary for wider implementation of Choosing Wisely recommendations.
authors.affiliation: Anthem Inc, Indianapolis, Indiana.
authors.forename: Alan
authors.initials: A
authors.lastname: Rosenberg
authors.affiliation: HealthCore Inc, Wilmington, Delaware.
authors.forename: Abiy
authors.initials: A
authors.lastname: Agiro
authors.affiliation: Anthem Inc, Indianapolis, Indiana.
authors.forename: Marc
authors.initials: M
authors.lastname: Gottlieb
authors.affiliation: HealthCore Inc, Wilmington, Delaware.
authors.forename: John
authors.initials: J
authors.lastname: Barron
authors.affiliation: Anthem Inc, Indianapolis, Indiana.
authors.forename: Peter
authors.initials: P
authors.lastname: Brady
authors.affiliation: Anthem Inc, Indianapolis, Indiana.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Anthem Inc, Indianapolis, Indiana.
authors.forename: Cindy
authors.initials: C
authors.lastname: Li
authors.affiliation: HealthCore Inc, Wilmington, Delaware.
authors.forename: Andrea
authors.initials: A
authors.lastname: DeVries
mesh_terms: D000328:Adult; D002755:Choice Behavior; D003695:Delivery of Health Care / Q000592:standards*; D018588:Fee-for-Service Plans / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D005102:Health Expenditures / Q000592:standards*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics* / Q000592:standards; D012189:Retrospective Studies; D014481:United States