(HealthDay News) — Significant decreases in low-value services were seen in accordance with two of seven early “Choosing Wisely” recommendations, according to a study published online in JAMA Internal Medicine.

Alan Rosenberg, M.D., from Anthem Inc. in Indianapolis, and colleagues used nationwide commercial health plan population-level data to quantify the frequency and trends of some of the early “Choosing Wisely” recommendations. They conducted a retrospective analysis of claims data from Anthem-affiliated health plan members. Seven low-value services were selected: imaging tests for uncomplicated headache; cardiac imaging without history of cardiac conditions; low back pain imaging without red-flag conditions; preoperative chest X-ray with unremarkable history and physical examination results; human papillomavirus testing for women younger than 30 years; antibiotic use for acute sinusitis; and prescription nonsteroidal anti-inflammatory drug (NSAID) use for hypertension, heart failure, or chronic kidney disease.

The researchers found that there were significant decreases in use of imaging for headache (14.9 to 13.4%) and cardiac imaging (10.8 to 9.7%). Increases were seen in NSAID use in select conditions (14.4 to 16.2%) and human papillomavirus testing (4.8 to 6%). The other recommendations did not change significantly.

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“These results suggest that additional interventions are necessary for wider implementation of ‘Choosing Wisely’ recommendations,” the authors write.

Several authors are employees of HealthCore, which is a wholly owned Anthem subsidiary; several authors are employees of Anthem. All authors have financial ties to Anthem, which provided research support.


  1. Rosenberg, A; Agiro, A; Gottlieb, M; et al. JAMA Intern Med. published online October 12, 2015; doi: 10.1001/jamainternmed.2015.5441.
  2. Ralph Gonzales and Adithya Cattamanchi. JAMA Intern Med. published online October 12, 2015; doi: 10.1001/jamainternmed.2015.5987.
  3. David H. Howard and Cary P. Gross. JAMA Intern Med. published online October 12, 2015; doi: 10.1001/jamainternmed.2015.5453.