Neurology Choosing Wisely recommendations: 74 and growing

Area of Science:

• Neurology
• Health Services Research
• Medical Economics

Background:

• The Choosing Wisely initiative aims to reduce unnecessary medical tests and procedures.
• Neurology faces challenges with test utilization and healthcare costs.
• Understanding neurology-specific recommendations is crucial for practice improvement.

Purpose of the Study:

• To identify and categorize all neurology-related Choosing Wisely recommendations.
• To assess the scope and focus of these recommendations across neurologic subspecialties.
• To inform future efforts aimed at improving neurologic care efficiency.

Main Methods:

• Systematic identification of Choosing Wisely items from 65 medical societies.
• Categorization of relevant items by neurologic specialty, disease/symptom, and test/treatment.
• Analysis of recommendation duplication and coverage across subspecialties.

Main Results:

• 74 out of 370 (20%) items were relevant to neurology, with 12 duplicated.
• Recommendations covered 10 neurologic subspecialties, but lacked coverage for movement disorders and neuromuscular disease.
• Many items questioned imaging, but few addressed other costly tests like EMG/nerve conduction studies and EEG.

Conclusions:

• A growing number of neurology-focused Choosing Wisely recommendations exist.
• Areas of consensus should be prioritized for immediate efficiency interventions.
• Gaps in recommendations highlight opportunities for future research and guideline development in high-cost neurologic testing.