Choose Your Tests Wisely: Advice From the AAO

Lauri R. Graham; William L. Rich III, MD


October 28, 2013

In This Article

Editor's Note:
Choosing Wisely®, an initiative of the American Board of Internal Medicine (ABIM) Foundation, comprises evidence-based recommendations from specialty organizations on commonly used tests and procedures. The goal of the campaign is to use these recommendations as the starting point for discussions between clinicians and patients about avoiding unnecessary care. Choosing Wisely launched in 2012 with 5 recommendations each from 9 specialties; more than 50 specialty societies have now joined the campaign, and more than 30 societies will announce new lists in late 2013 and early 2014. Medscape interviewed William L. Rich III, MD, of the American Academy of Ophthalmology (AAO), who helped craft its Choosing Wisely recommendations.

Medscape: Would you give a brief history of the AAO's involvement in the Choosing Wisely campaign and why you believed this would be important?

Dr. Rich: We, like most organizations in the country, are focused on quality, and it has become very apparent that efficiency and cost are now part of the quality equation. Certainly, societies did not consider that in the past, but it is part of the quality equation now, and we recognize the necessity of educating our members about these realities.

If you look at the natural adoption of studies into practice by doctors, it takes about 10 years, including those that demonstrate a more enhanced or efficient way of delivering care. So, in talking with the ABIM Foundation, which created the Choosing Wisely campaign and with whom we have worked in the past, we felt this to be an incredible organization to improve awareness about the issue of cost for both patients and physicians, and we could also show physicians the evidence base that will support any practice adopted by the Academy.

We went through a very methodical, evidence-based process to come up with these 5 recommendations. We started with our Quality of Care Committee under the leadership of Dr. Anne Coleman, who has been involved in this area within the Academy since the 1980s. The Quality of Care Committee in conjunction with the Health Policy Committee, of which I am the Medical Director for Health Policy, then identified areas that we felt were used excessively without a good evidence base. The Quality of Care Committee performed the research and provided a lengthy list, which was then honed down with consultation from other ophthalmic organizations and subspecialty societies.

We feel this is an important discussion for the doctor and the patient to have. We also feel it is important, in our small way, to help address the "bending of the cost curve" (one of those inside-the-Beltway terms) that we all hear about.


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