The American Society for Clinical Pathology Identifies List of Commonly Used Tests and Treatments to Question

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Group aims to encourage physician and patient conversations by identifying five tests or procedures to question, highlighting potentially unnecessary — sometimes harmful — care in pathology and laboratory medicine

ASCP is pleased to join the Choosing Wisely campaign because it is our responsibility to ensure evidence-based practices in the medical laboratory.

The American Society for Clinical Pathology (ASCP) today released a list of specific tests or procedures that are commonly ordered but not always appropriate in pathology and laboratory medicine as part of the Choosing Wisely® campaign, an initiative of the ABIM Foundation. The list identifies five targeted, evidence-based recommendations that can support conversations between patients and physicians about what care is really necessary.

ASCP’s list identified the following five recommendations:

  • Do not perform population-based screening for 25-OH-Vitamin D deficiency.
  • Do not perform low-risk human papillomavirus (HPV) testing.
  • Avoid routine preoperative testing for low-risk surgeries without a clinical indication.
  • Only order Methylated Septin 9 (SEPT9) on patients for whom conventional diagnostics are not possible.
  • Do not use bleeding time tests to guide patient care.

“ASCP is pleased to join the Choosing Wisely campaign because it is our responsibility to ensure evidence-based practices in the medical laboratory,” said Dr. E. Blair Holladay, ASCP Executive Vice President. “Measuring outcomes is essential in the fast-approaching evolution of health care and is underscored by the axiom, ‘right test, right patient, right time, at the right cost.’ Examples of inappropriate and over-utilized tests are pervasive throughout both anatomic and clinical pathology and laboratory medicine. The use of the low-risk human papillomavirus testing (HPV) for cervical cancer, which is proven to have no relationship to the development of cervical cancer, and the practice of unnecessary preoperative testing panels unrelated to the corresponding surgery are instances of inappropriate test utilization for patients.”

All the lists released today as part of the Choosing Wisely campaign were developed by individual specialty societies after months of careful consideration and review. Using the most current evidence about management and treatment options within their specialty, the societies believe the recommendations can make a significant impact on patient care, safety and quality.

The ASCP list was developed under the leadership of Lee Hilborne, MD, MPH, FASCP, DLM(ASCP)CM, 2011–2012 Chair of the ASCP Institute Advisory Committee and Past President of ASCP. Subject matter and test utilization experts across the fields of pathology and laboratory medicine were included in this process for their expertise and guidance. The review panel examined hundreds of options based on both the practice of pathology and evidence available through an extensive review of the literature. The medical laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and, eliminating it or changing to another test is within the control of the clinician. The final list is not exhaustive (many other tests/procedures were also identified and were also worthy of consideration), but the recommendations, if instituted, would result in higher quality care, lower costs, and more effective use of our medical laboratory resources and personnel. Dr. Hilborne has written articles about Choosing Wisely, which appear in the American Journal of Clinical Pathology and Critical Values magazine.

Releasing lists along with ASCP today are 16 other organizations representing more than 350,000 physicians, nurses, pathologists, radiologists and other healthcare professionals. They include:

  • American Academy of Family Physicians
  • American Academy of Hospice and Palliative Medicine
  • American Academy of Neurology
  • American Academy of Ophthalmology
  • American Academy of Otolaryngology—Head and Neck Surgery
  • American Academy of Pediatrics
  • American College of Obstetricians and Gynecologists
  • American College of Rheumatology
  • American Geriatrics Society
  • American Society of Echocardiography
  • American Urological Association
  • Society of Cardiovascular Computed Tomography
  • Society of Hospital Medicine
  • Society of Nuclear Medicine and Molecular Imaging
  • Society of Thoracic Surgeons
  • Society for Vascular Medicine

*Releasing a second list

Currently, healthcare delivery in the United States contains practices that may provide little, if any, benefit to patients. Pathologists and laboratory professionals need to play a leadership role in addressing these challenges, which is why ASCP joined the Choosing Wisely campaign in 2012 and is announcing its five initial tests today. It is critical that pathologists and laboratory professionals contribute to improving patient care and reducing the high cost of health care in the United States. Unnecessary testing may lead to inappropriate treatment decisions and consume unnecessary resources. The primary goal of the initiative is to avoid negative consequences associated with the overuse of medical services.

In April 2012, nine medical specialty societies each released lists as part of the Choosing Wisely campaign. To date more than 130 tests and procedures to question have been released as part of the campaign, and the specialty societies are now undertaking considerable efforts to share the recommendations with their collective membership of more than 725,000 physicians.

The campaign is also reaching millions of consumers nationwide through a stable of consumer partners, led by Consumer Reports—the world’s largest independent product-testing organization—which has worked with the ABIM Foundation to distribute patient-friendly resources for consumers and physicians to engage in these important conversations. Choosing Wisely consumer partners include:

  • AARP
  • Alliance Health Networks
  • The Leapfrog Group
  • Midwest Business Group on Health
  • Minnesota Health Action Group
  • National Business Coalition on Health
  • National Business Group on Health
  • National Center for Farmworker Health
  • National Hospice and Palliative Care Organization
  • National Partnership for Women & Families
  • Pacific Business Group on Health
  • SEIU
  • Union Plus
  • Wikipedia

In addition, the campaign announced specialty societies who will release new lists later in 2013:

  • American Academy of Dermatology
  • American Academy of Family Physicians**
  • American Academy of Orthopaedic Surgeons
  • American College of Rheumatology*
  • American College of Surgeons
  • American College of Chest Physicians
  • American Headache Society
  • AMDA—Dedicated to Long Term Care Medicine
  • American Society of Clinical Oncology*
  • American Society for Hematology
  • American Society for Radiation Oncology
  • American Thoracic Society
  • Heart Rhythm Society
  • North American Spine Society
  • Society of General Internal Medicine

*Releasing a second list
**Releasing a third list

To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit http://www.ChoosingWisely.org.

About ASCP
Founded in 1922 in Chicago, ASCP is a medical professional society with more than 100,000 member board-certified anatomic and clinical pathologists, pathology residents and fellows, laboratory professionals, and students. ASCP provides excellence in education, certification, and advocacy on behalf of patients, pathologists, and laboratory professionals. For more information, visit http://www.ascp.org; connect with us on Facebook or follow us on Twitter.

About the ABIM Foundation
The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit http://www.abimfoundation.org, read our blog blog.abimfoundation.org, connect with us on Facebook or follow us on Twitter.

About Choosing Wisely
First announced in December 2011, Choosing Wisely is part of a multi-year effort led by the ABIM Foundation to support and engage physicians in being better stewards of finite health care resources. Participating specialty societies are working with the ABIM Foundation and Consumer Reports to share the lists widely with their members and convene discussions about the physician’s role in helping patients make wise choices. Learn more at http://www.ChoosingWisely.org.

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