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Appraising the Evidence Supporting Choosing Wisely® Recommendations.

Andrew J Admon1,2, Ashwin Gupta3,4, Margaret Williams5

  • 1Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. ajadmon@umich.edu.

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Summary

The evidence supporting Choosing Wisely® recommendations varies, with many citing clinical practice guidelines (CPGs) or lower-quality data. This study analyzed the evidence strength for these important healthcare recommendations.

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Area of Science:

  • Health Services Research
  • Evidence-Based Medicine

Background:

  • The Choosing Wisely® campaign promotes evidence-based healthcare practices.
  • The evidentiary basis for Choosing Wisely® recommendations requires thorough investigation.

Purpose of the Study:

  • To evaluate the strength of evidence underpinning Choosing Wisely® recommendations.
  • To assess the quality of referenced clinical practice guidelines (CPGs).

Main Methods:

  • Extracted references for 320 Choosing Wisely® recommendations.
  • Categorized evidence strength for each recommendation.
  • Assessed a sample of referenced CPGs using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument.

Main Results:

  • 70.3% of recommendations cited CPGs as the highest evidence level; 22.2% cited primary research.
  • 7.8% cited lower-quality evidence (case series, reviews, editorials).
  • Median AGREE II scores for sampled CPGs were 54.2% overall and 58.3% for hospital medicine CPGs.

Conclusions:

  • Choosing Wisely® recommendations are supported by a range of evidence strengths.
  • The quality of referenced CPGs, as assessed by AGREE II, indicates room for improvement.