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Choosing Wisely Top 12 Recommendations

Choosing Wisely isa campaign that began in 2012 to stimulate conversations between physicians and patients about unnecessary tests, treatments, and procedures. Since its launch in the United States, the campaign has been adopted by more than 20 countries worldwide.

This year, the ABIM Foundation identified the Top 12 list of Choosing Wiselyrecommendations that have realized the largest decrease in unnecessary tests and procedures. Success was defined as a 10 percent decrease in unnecessary tests or procedures. This list was created using an analysis of reports created by the incremental cost-effectiveness ratio (ICER) and successful implementation projects gathered through grantee metrics, peer-reviewed journals and an informal environmental scan of implementation within the Choosing Wiselylearning network. Sources included 18 peer-reviewed journals, 14 health systems and 34 self-reported results from learning network members. The Choosing Wisely “Top 12” included:

  1. Use of antibiotics in patients with upper respiratory infections. Based on recommendations from American Academy of Allergy, Asthma, & ImmunologyAmerican Academy of Family PhysiciansAmerican Academy of PediatricsAmerican College of Emergency Physicians and Infectious Diseases Society of America
  1. Imaging for nonspecific low back pain– Based on recommendations from American Academy of Family PhysiciansAmerican Association of Neurological Surgeons and Congress of Neurological Surgeons,American Chiropractic AssociationAmerican College of Emergency PhysiciansAmerican College of PhysiciansAmerican Society of Anesthesiologists-Pain Management and North American Spine Society
  1. Imaging for uncomplicated or stable headaches. Based on recommendations from American College of Radiology
  1. Vitamin-D testing. Based on recommendations from American Academy of PediatricsAmerican Society for Clinical Pathology and Endocrine Society
  1. Repetitive CBC and lab. Based on recommendations from Critical Care Societies Collaborative and Society of Hospital Medicine
  1. In-patient blood utilization. Based on recommendations from AABBAmerican College of Obstetricians and GynecologistsAmerican Society of AnesthesiologistsAmerican Society of HematologyCritical Care Societies Collaborative and Society of Hospital Medicine
  1. Routine annual cervical cytology screening (Pap tests). Based on recommendations fromAmerican College of Obstetricians and Gynecologists and American Society for Colposcopy and Cervical Pathology
  1. Benzodiazepines for adults 65 years of age and older. Based on recommendations fromAmerican Academy of Nursing  and American Geriatrics Society
  1. Preoperative testing in patients scheduled to undergo low- and/or intermediate-risk non-cardiac surgery. Based on recommendations from American Academy of OphthalmologyAmerican College of PhysiciansAmerican College of RadiologyAmerican College of SurgeonsAmerican Society of AnesthesiologistsAmerican Society for Clinical PathologyAmerican Society of Echocardiography and Society of Thoracic Surgeons
  1. Telemetry in non-invasive care unit. Based on recommendations fromSociety of Hospital Medicine
  1. Antibiotics beyond 72 hours for inpatients with no signs ofinfection. Based on recommendations from Society for Healthcare Epidemiology of America 
  1. DEXAscans. Based on recommendations from American Academy of Family Physicians and American College of Rheumatology

Four of the 12 recommendations regard reduction in laboratory testing including vitamin D screening, repetitive routine laboratory tests, annual routine cervical cytology screening, and preoperative testing for low to intermediate risk noncardiac surgery. One of the 12 addresses patient blood management.

The success of the campaign in the next 5 years will be measured by the ongoing engagement of physicians in these interventions and, more importantly, how well it actually reduces unnecessary tests, procedures and treatments. 


Levinson, W. et al. Choosing Wisely Campaigns: A Work in Progress. JAMA published online April 19, 2018, E1-E2.

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