Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.
Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, NSW, Australia.
BMC Health Serv Res. 2019 Nov 11;19(1):707. doi: 10.1186/s12913-019-4576-1.
It is unknown to what extent Choosing Wisely recommendations about income-generating treatments apply to members of the society generating the recommendations. The primary aim of this study is to determine the proportion of Choosing Wisely recommendations targeting income-generating treatments, and whether recommendations from professional societies on income-generating treatments are more likely to target members or non-members. The secondary aim is to determine the prevalence of qualified statements, and whether qualified statements are more likely to appear in recommendations targeting income-generating or non-income-generating treatments that apply to members.
We performed a content analysis of all Choosing Wisely recommendations, with data extracted from Choosing Wisely websites. Two researchers coded recommendations as test or treatment-based, for or against a procedure, containing qualified statements, income-generating and applying to members. Disagreements were resolved by discussion or consultation with a third researcher. A Chi-squared test evaluated whether society recommendations on income-generating treatments were more likely to target members or non-members; and whether qualified statements were more likely to appear in recommendations targeting income-generating or non-income-generating treatments that apply to members.
We found 1293 Choosing Wisely recommendations (48.3% tests and 48.6% treatments). Ninety-eight treatment recommendations targeted income-generating treatments (17.8%), and recommendations on income-generating treatments were less likely to target members compared to non-members (15.6% vs. 40.4%, p < 0.001). Nearly half of all recommendations were qualified (41.9%), with a similar proportion of recommendations targeting income-generating and non-income-generating treatments that apply to members containing qualified statements (49.4% vs. 42.0%, p = 0.23).
Many societies provide Choosing Wisely recommendations that minimise impact on their own members. Only 20% of treatment recommendations target income-generating treatments, and of these recommendations mostly target non-members. Many recommendations are also qualified. Increasing the number of recommendations from societies that are unqualified and target member clinicians responsible for de-implementation of low-value and costly treatments should be a priority.
目前尚不清楚《明智选择》（Choosing Wisely）中有关创收治疗的建议在多大程度上适用于提出这些建议的社会成员。本研究的主要目的是确定针对创收治疗的《明智选择》建议的比例，以及针对创收治疗的专业学会建议是否更有可能针对成员或非成员。次要目的是确定合格声明的流行程度，以及合格声明是否更有可能出现在针对成员的创收或非创收治疗的建议中。
我们对所有《明智选择》建议进行了内容分析，数据来自《明智选择》网站。两位研究人员根据是否为测试或治疗方法、支持或反对某项操作、是否包含合格声明、是否创收以及是否适用于成员对建议进行编码。意见分歧通过讨论或咨询第三位研究人员解决。卡方检验用于评估针对创收治疗的学会建议是否更有可能针对成员或非成员，以及合格声明是否更有可能出现在针对成员的创收或非创收治疗的建议中。
我们发现 1293 条《明智选择》建议（48.3%为测试，48.6%为治疗）。98 条治疗建议针对创收治疗，与非成员相比，针对创收治疗的建议更不可能针对成员（15.6%比 40.4%，p<0.001）。近一半的建议都是合格的（41.9%），针对成员的创收和非创收治疗的建议中，包含合格声明的比例相似（49.4%比 42.0%，p=0.23）。
许多学会提供的《明智选择》建议尽量减少对其成员的影响。只有 20%的治疗建议针对创收治疗，其中大部分针对非成员。许多建议也是合格的。增加那些不合格且针对负责减少低价值和高成本治疗的成员的学会建议数量应成为优先事项。
