Limiting Low-Value Care by “Choosing Wisely”

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The Dartmouth Atlas of Health Care has long documented widespread variations in use of effective care. Needed attention is now being paid to use of ineffective—or low-value—care, a form of overtreatment. In 2009, the American Board of Internal Medicine (ABIM) Foundation gave a grant to the National Physicians Alliance to develop lists to help primary physicians “be good stewards of resources.” In March 2011, the ABIM Foundation announced their Choosing Wisely campaign. The Choosing Wisely campaign is a collaborative effort by the ABIM Foundation, Consumer Reports, and leading medical specialty societies that identified common tests or procedures whose necessity should be questioned and discussed. This article provides background information to the Choosing Wisely campaign and discusses how the lists of items used for the campaign were developed. Although there is considerable variation in the methodologies used to develop the lists included in the campaign, and not all of the list items are likely to significantly reduce utilization of low-value care, it is a good starting point from which to begin a conversation about unnecessary care and policy interventions to curtail it.

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