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Choosing wisely: The American College of Rheumatology's top 5 list of things physicians and patients should question
Author(s) -
Yazdany Jinoos,
Schmajuk Gabriela,
Robbins Mark,
Daikh David,
Beall Ashley,
Yelin Edward,
Barton Jennifer,
Carlson Adam,
Margaretten Mary,
Zell JoAnn,
Gensler Lianne S.,
Kelly Victoria,
Saag Kenneth,
King Charles
Publication year - 2013
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.21930
Subject(s) - medicine , rheumatology , family medicine , respondent , delphi method , rheumatism , generalizability theory , workforce , physical therapy , psychology , statistics , developmental psychology , mathematics , political science , law , economics , economic growth
Abstract Objective We sought to develop a list of 5 tests, treatments, or services commonly used in rheumatology practice whose necessity or value should be questioned and discussed by physicians and patients. Methods We used a multistage process combining consensus methodology and literature reviews to arrive at the American College of Rheumatology's (ACR) Top 5 list. Rheumatologists from diverse practice settings generated items using the Delphi method. Items with high content agreement and perceived high prevalence advanced to a survey of ACR members, who comprise >90% of the US rheumatology workforce. To increase the response rate, a nested random sample of 390 rheumatologists received more intensive survey followup. The samples were combined and weighting procedures were applied to ensure generalizability. Items with high ratings underwent literature review. Final items were then selected and formulated by the task force. Results One hundred five unique items were proposed and narrowed down to 22 items during the Delphi rounds. A total of 1,052 rheumatologists (17% of those contacted) participated in the member‐wide survey, whereas 33% of those in the nested random sample participated; respondent characteristics were similar in both samples. Based on survey results and available scientific evidence, 5 items (relating to antinuclear antibodies, Lyme disease, magnetic resonance imaging, bone absorptiometry, and biologic therapy for rheumatoid arthritis) were selected for inclusion. Conclusion The ACR Top 5 list is intended to promote discussions between physicians and patients about health care practices in rheumatology whose use should be questioned and to assist rheumatologists in providing high‐value care.