Choosing Wisely in Oncology: Are We Ready For Value-Based Care?

Area of Science:

• Oncology
• Healthcare Quality Improvement
• Clinical Practice Guidelines

Background:

• The American Society of Clinical Oncology (ASCO) developed the Choosing Wisely (CW) list in 2012 to identify low-value tests and procedures.
• ASCO's Quality Oncology Practice Initiative (QOPI) incorporates measures based on these CW recommendations.

Purpose of the Study:

• To evaluate concordance rates with ASCO's Choosing Wisely (CW) measures.
• To assess changes in concordance over time.
• To examine variability in concordance based on practice characteristics.

Main Methods:

• Analysis of CW test measures from 2013 to 2015 across 341 oncology practices.
• Evaluation of concordance rates, temporal changes, and practice-specific variations.
• Statistical analysis including medians, interquartile ranges, percentages, and linear regression models.

Main Results:

• Concordance rates with CW measures varied significantly among practices.
• Highest median concordance was observed for chemotherapy in patients with low performance status (78.4%-83.3%).
• Lowest median concordance was for biomarker/imaging use in early breast cancer surveillance (67.7%-74.2%).

Conclusions:

• Performance on ASCO's CW measures indicates a need for improvement.
• Substantial variation in concordance rates by practice highlights disparities in implementation.
• Enhanced education on CW measures is recommended to improve patient care and healthcare value.