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How Neurologists Can Choose (Even More) Wisely Prioritizing Waste Reduction Targets and Identifying Gaps in Knowledge

Brian C. Callaghan, MD1; James F. Burke, MD, MS1; Eva L. Feldman, MD, PhD2
[+] Author Affiliations
1Health Services Research Program, Department of Neurology, University of Michigan, Ann Arbor
2A. Alfred Taubman Medical Research Institute, Department of Neurology, University of Michigan, Ann Arbor
JAMA. 2014;311(16):1607-1608. doi:10.1001/jama.2014.1021.
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Health care accounts for a large, and escalating, proportion of the gross domestic product, yet the overall value of many of these expenditures is unclear. The Institute of Medicine estimates that $750 billion could be saved annually by reducing health care inefficiencies, including $210 billion by eliminating unnecessary services.1 A recent attempt to reduce these unnecessary services, the Choosing Wisely campaign aims to stimulate a conversation between physicians and patients about the necessity of tests, procedures, and medications. The initial Choosing Wisely lists, including 1 from the American Academy of Neurology (AAN),2 represent an essential first step in the reduction of waste. Moving forward, physicians can choose even more wisely. To do so requires a framework for the complex task of prioritizing waste reduction targets out of the innumerable combination of tests, procedures, and medications.

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Net Benefit, Net Cost, and Benefit to Cost Certainty of Recent Neurologic Choosing Wisely Targets

Schematic representation of waste reduction target prioritization, representing the 3 elements of the framework. The Y-axis represents net benefit and the X-axis represents net cost. The length of each rectangle in the Y- and X-planes illustrates uncertainty in the net benefit and net cost estimates for each target. Three neurologic Choosing Wisely targets are illustrated using blue rectangles. Examples of positive net benefit targets are in the green region (guideline recommended) and negative net benefit targets are in the red region (guideline opposed).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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