The National Physicians Alliance, the mission of which is to achieve affordable, high-quality healthcare for all patients, launched its Promoting Good Stewardship in Medicine project in 2009 with ABIM Foundation funding. The project’s goal was to identify five things primary care physicians could do in their daily practices to ensure high-quality, affordable care. The products of this work were three “Top 5” lists—for internal medicine, family medicine, and pediatrics—which were published in August 2011. The lists included some items of interest to rheumatologists, such as imaging for low back pain and DXA screening for osteoporosis.2
ABIM Foundation Choosing Wisely Campaign
The NPA Good Stewardship project served as the model for the ABIM Foundation’s ongoing Choosing Wisely campaign, which aims to promote conversations between physicians and patients by helping patients choose care that is evidence-based, not duplicative of other tests or procedures already received, not harmful, and truly necessary. Nine professional societies participated in Phase 1, including allergy and immunology, family practice, cardiology, internal medicine, radiology, gastroenterology, clinical oncology, nephrology, and nuclear medicine. Their efforts produced nine lists that were released in April 2012 to a flurry of national and local media coverage. The overwhelmingly positive coverage highlighted not only the 45 items to carefully consider, but also the engagement of physicians in these important value discussions.
ACR Involvement
The ACR decided in early 2012 to join Phase 2 of the Choosing Wisely campaign. ACR deliberations had already begun about how to best demonstrate and quantify value within rheumatology, and Choosing Wisely was a perfect opportunity to join our internal discussion with the national dialogue. Sixteen other organizations released lists in late February as part of Phase 2. In addition to the ACR, Phase 2 participants included hospice and palliative medicine, neurology, ophthalmology, otolaryngology–head and neck surgery, pediatrics, obstetrics and gynecology, geriatrics, clinical pathology, echocardiography, urology, cardiovascular computed tomography, hospital medicine, nuclear medicine and molecular imaging, thoracic surgery, vascular medicine, and family practice.
Rheumatology’s Five Things
The ACR developed its list with substantial input from the ACR membership and significant effort by several ACR members who volunteered to serve on the Top 5 Task Force. They were led by Dr. Jinoos Yazdany, of the University of California at San Francisco, and Dr. Charles King II, in private practice in Tupelo, Miss. The five things physicians and their patients should question in rheumatology include items related to treatment, imaging, and labs. More details about these items and the deliberations that led to their selection can be found at www.rheumatology.org/FiveThings.