Arthur S. Hong (
Dennis Ross-Degnan is an associate professor and director of research in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute.
Health Aff (Millwood). 2017 Apr 1;36(4):671-679. doi: 10.1377/hlthaff.2016.1263.
Choosing Wisely was launched by the American Board of Internal Medicine in April 2012 as a patient- and clinician-targeted campaign to reduce potentially unnecessary "low-value" medical services. The campaign's impact on low- and high-value care beyond its first year is unknown; furthermore, it is unknown whether some patients such as members of consumer-directed health plans and people residing in different US regions have responded more than others. To evaluate the impact of Choosing Wisely, we used commercial insurance claims to track changes in the use of low-value imaging (x-ray, computed tomography, and magnetic resonance imaging) for back pain before and after the campaign began, a period running from 2010 to 2014. We selected back pain imaging because it is a prominent target of Choosing Wisely, which considers it low value except in a minority of cases, because of its relatively high out-of-pocket expense, and the large volume of low back pain visits nationally. We found only a 4 percent relative reduction in low-value back imaging 2.5 years after the start of the campaign and some differences in regional trends, but no differences associated with enrollment in consumer-directed health plans. Our findings highlight the ongoing challenge of reducing unnecessary medical care, even when patients have "skin in the game" under consumer-directed health plans.
“明智选择”项目由美国内科医师学会于 2012 年 4 月发起，以患者和临床医生为目标，旨在减少潜在的不必要的“低价值”医疗服务。该活动在其开展的第一年之后对低价值和高价值护理的影响尚不清楚；此外，也不知道某些患者（如消费者导向的健康计划成员和居住在美国不同地区的人）是否比其他患者反应更强烈。为了评估“明智选择”的影响，我们使用商业保险索赔来跟踪 Campaign 开始前后背痛的低价值成像（X 光、计算机断层扫描和磁共振成像）的使用变化，时间跨度从 2010 年到 2014 年。我们选择背痛成像，是因为它是“明智选择”的一个突出目标，除了少数情况下认为其具有低价值外，因为它的自付费用相对较高，而且全国背痛就诊量很大。我们发现，在 Campaign 开始后的 2.5 年内，低价值的背部成像仅相对减少了 4%，并且存在地区趋势差异，但与消费者导向的健康计划的参与无关。我们的研究结果强调了即使在消费者导向的健康计划下患者有“切身利益”，减少不必要的医疗护理仍然是一个持续的挑战。
