A new study reported in JAMA Internal Medicine analyzed all Choosing Wisely recommendations by U.S.-based physician societies from 2012 to 2021 to assess the services, clinical contexts and consequences of low-value services. Among the findings:

Low-value services identified in the 626 Choosing Wisely recommendations largely covered imaging and laboratory studies in the context of chronic conditions and healthy patients with risk factors alone.
Most of the identified low-value services were revenue-neutral for the recommending society, and the plurality were low cost.
Low-cost services represented a growing share of low-value services identified by Choosing Wisely recommendations.
Nearly half of recommendations identified services with high direct harm potential, and 388 identified those with high potential for triggering downstream services, or cascades.

"Taken together, the results of this qualitative study point to the successes of Choosing Wisely to date, as well as an opportunity to explicitly prioritize future recommendations and interventions to maximize impact across the dimensions of spending across populations, direct harms and cascades," according to the report. "Current recommendations do identify many potentially high-impact, low-value services. Clinical leaders, payers and policymakers might use the coded recommendations to target such services for intervention based on individual priorities."

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Reducing low-value care: Awareness, education efforts need to evolve

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