Researchers: Maya Leventer-Roberts¹, Ziv Rosenbaum², Moshe Hoshen¹, Becca Feldman¹

Background: The Choosing Wisely Campaign was launched by the Institute of Medicine in 2012 by releasing diagnostic procedures or treatments which lack clinical justification for routine use according to expert opinion and evidence based medicine.

Objectives: Clalit Health Services has been keenly interested in better understanding the rates and descriptive features of diagnostic imaging that has been shown not to provide benefit for patients. Two prime examples are routine imaging in the context of pre-admission or emergency department assessment and abdominal CT to rule out appendicitis.

Method: This is a cross-sectional rolling cohort study between 2008 and 2017.
There are two distinct cohorts; first, all adult visits to a Clalit Emergency Department (ED) who lacked a diagnostic indication for CXR.
The second cohort was all children visits to a Clalit ED for abdominal pain or appendicitis. The outcome of interest for this cohort was what type of imaging they received.

Findings: Of the 3,689,869 visits in the first cohort, 9.1% or 337,058 of them received a CXR. Of the 35,973 visits in the second cohort, 7.2% of them had no imaging performed, 82.3% had an US, 6.9% had an US followed by a CT, and 3.6% or 1,293 of them received a CT. The models suggested that the independent risk factors for having diagnostic imaging that is not clinically indicated include BMI, Hospital, SES, sex, year, and presenting or underlying diagnosis.

Conclusions: We find that despite improvement following the introduction of the Choosing Wisely campaign, these diagnostic imaging practices continue to be applied inconsistently across the population.

Recommendations: By focusing our efforts on those at greatest risk, we have better opportunities to improve our impact of reducing exposure to unnecessary imaging, reduce overall healthcare consumption, and improve the patient experience.

Research end date: 12/2018