Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM on Bluesky
  • JABFM On Facebook
  • JABFM On Twitter
  • JABFM On YouTube
Research ArticleOriginal Research

Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely™

Amanda Kost, Inginia Genao, Jay W. Lee and Stephen R. Smith
The Journal of the American Board of Family Medicine July 2015, 28 (4) 471-474; DOI: https://doi.org/10.3122/jabfm.2015.05.140332
Amanda Kost
From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS).
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Inginia Genao
From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS).
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jay W. Lee
From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS).
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Stephen R. Smith
From the Department of Family Medicine, University of Washington, Seattle (AK); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (IG); Long Beach Memorial Family Medicine Residency, Long Beach, CA (JWL); and the Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI (SRS).
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Tables

    • View popup
    Table 1. Choosing Wisely Recommendations; Study Sites; Inclusion, Exclusion, and Appropriate Decision Criteria; and Recommendation Adherence for a 6-Month Time Period Before and After the Intervention*
    Recommendation (Specialty Society)Study SitesCriteriaBefore Intervention Percent AppropriateAfter Intervention Percent AppropriateP Value
    InclusionExclusionAppropriate DecisionInappropriate Decision
    Low-back pain (AAFP and ACP): Don't do imaging for low back pain within the first six weeks, unless red flags are present.Yale,† Long Beach,‡ Seattle§ICD-9 codes 724.4, 724.3, 724.02, 724.4, 724.5, 722.1, 722.2, 722.5, 722.51, 722.9, 846.0, 847.2Age <18 years, prior visit for acute back pain within the prior 3 months, preexisting chronic back pain, temperature >38°C, new-onset bowel or bladder symptoms, “saddle” anesthesia, prior cancer diagnosis, current IV drug use, unexplained weight lossNo imaging ordered for back painImaging ordered for back pain87.8 (108/123)87.8 (81/94).99
    Sinusitis (AAFP): Don't routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for ≥7 days OR symptoms worsen after initial clinical improvement.Long Beach, SeattleICD-9 codes 461.0, 461.1, 461.3, 461.8, 461.9Age <12 years, prior visit for sinusitis within 3 months, temperature of 38°C, symptom duration >7 days, double sickening, severe pain or tenderness over sinuses, another diagnosis requiring antibioticsNo antibiotics prescribedAntibiotics prescribed45.4 (10/22)100 (21/21)<.00
    Pap tests (AAFP): Don't perform Pap tests on women <21 years old or women who have had a hysterectomy for noncancer disease.Long Beach, SeattleAll pap smears performed—Patient age >21 years, Pap performed on patient with hysterectomy for prior malignancyPatient age <21 years or Pap done on patient with hysterectomy for noncancer indication98.8 (237/240)99.3 (272/274).55
    ECG (AAFP and ACP): Don't order annual ECGs or any other cardiac screening for low-risk patients without symptoms.Yale, Long Beach, SeattleAll ECGs performed—ECG ordered for cardiac or pulmonary symptoms, or for patients with hypertension, diabetes mellitus, or other clinical indicationECG ordered for screening purposes99.2 (119/120)99.2 (129/130).96
    DEXA scanning (AAFP and ACP): Don't use DEXA screening for osteoporosis in women <65 years old or men <70 years with no risk factors.Yale, Long Beach, SeattleAll DEXAs orderedPatient age <18 yearsWomen >65 years old, men >70 years old, patients of any age with an underlying medical condition that increases osteoporosis riskWomen <65 years old without risk factors, men <70 years old without risk factors66.7 (8/12)90.0 (36/40).049
    All decisions—————93.2 (482/517)96.5 (552/572).02
    • ↵* The preintervention period included clinical decisions made between July 1 and December 31, 2011; the postinterventionperiods included clinical decisions made between April 26 and October 26, 2012.

    • ↵† Yale Primary Care Center, New Haven, CT, is the outpatient clinic for the Internal Medicine Residency.

    • ↵‡ Long Beach Memorial Family Medicine Residency, Long Beach, CA.

    • ↵§ Harborview Medical Center Family Medicine Clinic is a satellite clinic for University of Washington Family Medicine Residency, Seattle, Washington.

    • AAFP, American Academy of Family Physicians; ACP, American College of Physicians; DEXA, dual-energy X-ray absorptiometry; ECG, electrocardiogram; ICD-9, International Classification of Diseases, Ninth Revision; IV, intravenous.

PreviousNext
Back to top

In this issue

The Journal of the American Board of Family     Medicine: 28 (4)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 4
July-August 2015
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely™
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely™
Amanda Kost, Inginia Genao, Jay W. Lee, Stephen R. Smith
The Journal of the American Board of Family Medicine Jul 2015, 28 (4) 471-474; DOI: 10.3122/jabfm.2015.05.140332

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely™
Amanda Kost, Inginia Genao, Jay W. Lee, Stephen R. Smith
The Journal of the American Board of Family Medicine Jul 2015, 28 (4) 471-474; DOI: 10.3122/jabfm.2015.05.140332
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Conclusion
    • Notes
    • References
  • Figures & Data
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Low-value practices in primary care: a cross-sectional study comparing data between males and females in Spain
  • Barriers and facilitators to reduce low-value care: a qualitative evidence synthesis
  • How common is imaging for low back pain in primary and emergency care? Systematic review and meta-analysis of over 4 million imaging requests across 21 years
  • Physician Cost Consciousness and Use of Low-Value Clinical Services
  • Re: Clinical Decisions Made in Primary Care Clinics Before and After Choosing Wisely&trade;
  • Timely and/or Controversial Information for Family Physicians
  • Google Scholar

More in this TOC Section

  • Integrating Adverse Childhood Experiences and Social Risks Screening in Adult Primary Care
  • A Pilot Comparison of Clinical Data Collection Methods Using Paper, Electronic Health Record Prompt, and a Smartphone Application
  • Associations Between Modifiable Preconception Care Indicators and Pregnancy Outcomes
Show more Original Research

Similar Articles

Keywords

  • Cost Control
  • Decision Making

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2025 American Board of Family Medicine

Powered by HighWire