Lara C. Pullen, PhD

November 01, 2013

CHICAGO, Illinois — The collaborative task force of the American College of Chest Physicians (ACCP) and the American Thoracic Society has released its list of 5 recommendations in pulmonary care as part of the Choosing Wisely campaign.

The list will help physicians "provide our patients with excellent care while at the same time being good stewards of resources," elaborated Dan Ouellette, MD, from Henry Ford Hospital in Detroit, Michigan, to Medscape Medical News. Dr. Ouellette was a member of the task force that identified the 5 targeted, evidence-based recommendations. The list was released here at CHEST 2013: American College of Chest Physicians Annual Meeting and will be published in the ACCP's journal CHEST in 2014.

The recommendations in pulmonary care are:

  1. "Don't perform computed tomography (CT) surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines."

  2. "Don't routinely offer pharmacologic treatment with advanced vasoactive agents approved only for the management of pulmonary arterial hypertension to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases (Groups II or III pulmonary hypertension)."

  3. "For patients recently discharged on supplemental home oxygen after hospitalization for an acute illness, don't renew the prescription without assessing the patient for ongoing hypoxemia."

  4. "Don't perform chest computed tomography (CT angiography) to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay."

  5. "Don't perform CT screening for lung cancer among patients at low risk for lung cancer."

Multiple professional societies have contributed to the Choosing Wisely effort. "It originated about a decade ago. It arose from the [American Board of Internal Medicine (ABIM)] Foundation with the intention that physicians should play a role in identifying tests or interventions that are commonly done but don't necessarily have a lot of evidence supporting them," Curtis Sessler, MD, FCCP, president elect of the ACCP, told Medscape Medical News.

"Physicians should apply evidence-based medicine to deciding when to order tests.... It becomes incumbent on physicians to be parsimonious with the use of resources," agreed Dr. Ouillette.

Societies are encouraged to come up with their "top 5" recommendations, and these are published with the intention of influencing the practice of medicine. The lists are chosen carefully.

"Physicians in the past could focus simply on what the needs of their patients were.... Best care in 2013 also means that we are stewards of our resources," explained Dr. Ouillette.

The Choosing Wisely campaign is a "great idea," Dr. Sessler explained. "It is intended to empower patients and their families to have that conversation with their physician." The ABIM Foundation intends that the lists be considered by physicians and patients, as well as payers. To that end, consumer and advocacy partners, led by Consumer Reports, are working with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians.

During the session, Dr. Sessler also described the status of the critical care medicine Choosing Wisely list. The list is being created by the Critical Care Societies Collaborative, which includes the ACCP, American Thoracic Society, American Association of Critical-Care Nurses, and Society of Critical Care Medicine.

The collaboration represents the largest Choosing Wisely collaboration as well as the first to include a nursing society. The critical care medicine task force opened with a call for ideas.

The task force discussed and scored 58 recommendations. The 9 with the most support then were further researched. The task force will use a data-driven approach to determine the 5 best recommendations. The items are currently being scored on the basis of strength of evidence, prevalence, aggregate cost, relevance, and innovation.

The task force will next vote to determine the top 5 recommendations. The critical care list will be announced in January at the SCCM annual meeting.

Dr. Ouellette and Dr. Sessler have disclosed no relevant financial relationships.

CHEST 2013: American College of Chest Physicians Annual Meeting. Presented August 28, 2013.


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