Abstract
BackgroundThe Choosing Wisely campaign has spread to many countries. Methods for developing recommendations are inconsistent. We describe our process of developing such recommendations from a comprehensive national set of clinical practice guidelines (Current Care, CC) and the results of a one-year Choosing Wisely Finland project.MethodsTwo of the authors drafted the quality and process criteria for all the Choosing Wisely Finland recommendations. The quality criteria were relevance, feasibility, evidence-based and strength. These were discussed in editors’ meetings and subsequently revised. Two different processes for developing recommendations within national clinical practice guidelines were designed and piloted (processes A and B). Process A was based on a published guideline. The recommendations are drafted by an editor and revised and approved by the guideline development group. In process B the development of the recommendations is integrated with guideline production or update. Choosing Wisely recommendations were then drafted for half of the published CC Guidelines. An additional process (process C) was designed for producing independent recommendations outside a guideline.ResultsAt least one Choosing Wisely recommendation could be identified from 39 out of 52 reviewed guidelines. Of the 106 recommendations drafted, 62 (58%) were accepted for publication. The main reasons for rejection were inability to give a strong recommendation (n = 18, 41%) and insufficient relevance (n = 14, 32%). Two thirds (n = 41, 66%) of the published recommendations were based on high to moderate level of evidence, and 18% (n = 11) on low or very low level of evidence, whereas for the rest, the quality of evidence was not critically appraised.ConclusionsChoosing Wisely recommendations can be produced systematically from existing clinical practice guidelines. The rigorous methods of evidence-based medicine ensure high-quality recommendations. We welcome the use of our processes and methods describes in this article by other guideline-producing organizations.
Highlights
The Choosing Wisely campaign has spread to many countries
Systematically produced health technology assessments (HTAs) have guided the implementation of new technologies in hospitals, including consensus recommendations to limit the spread of lowvalue technologies [8]
For Choosing Wisely Finland, we aimed to describe criteria that guaranteed transparent, consistent, and evidencebased medicine (EBM)-based methodology and that was suited for guideline producers
Summary
The Choosing Wisely campaign has spread to many countries. We describe our process of developing such recommendations from a comprehensive national set of clinical practice guidelines (Current Care, CC) and the results of a one-year Choosing Wisely Finland project. The Choosing Wisely campaign was launched in 2012 to support discussions between physicians and patients [3] about avoiding low-value care. The campaign invited medical specialty societies in the US to produce top 5 lists of low-value services. The criteria for topic selection were that the procedure is used frequently, carries a significant cost, may expose patients to harm or burden, or may increase strain on the health care system. In Germany a manual and criteria have been published for developing Choosing Wisely recommendations [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
