This list identifies the top five tests and treatments that should lead to careful discussions between rheumatologists and their patients to be sure decisions are being made that ensure high-quality patient care while also conserving healthcare resources.
“If we are going to build a healthcare system that provides high-quality care without wasting resources, it is absolutely critical that physicians demonstrate leadership,” says Jinoos Yazdany, MD, MPH, co-chair of the ACR task force that selected rheumatology’s top-five list and assistant professor at the University of California at San Francisco. “Providers know which cuts are likely or unlikely to hurt our patients. It is an ethical imperative that we lead the way while protecting the clinical needs of our patients.”
The eight-member task force was formed to oversee the multistage process that led to the final recommendations. The group was co-chaired by Dr. Yazdany and Charles M. King II, MD, who also chairs the ACR Committee on Rheumatologic Care.
“We thought it was very important that we go to the source to generate this list,” says Dr. Yazdany. “We asked rheumatologists who spend their lives caring for patients to think about waste they see in their communities and practices. We wanted suggestions from clinicians about ways to safely reduce costs without harming patients.”
A core membership group of about 20 practicing physicians was given the task of generating the first cut of the list. This initial round resulted in 105 unique items for further consideration.
“The core group was carefully selected to reflect the diversity of the College,” says Dr. King, who is also senior rheumatologist with Northern Mississippi Health Systems in Tupelo. “It was important that, to the extent possible, [the core group] reflected the age, gender, geographic distribution, and practice type of the general ACR membership with an emphasis on rheumatologists in clinical practice.”
The core group went through three Delphi rounds where participants ranked the items based on their agreement with content of the suggestion, prevalence of the item in their community, and highest impact on costs. At the end, 22 items were included in the next phase of the project, sending a survey to the entire ACR membership and asking them for input.
“I don’t know what we expected in the way of feedback, but the response was nothing short of phenomenal,” Dr. Yazdany says. “We were pleasantly surprised by how engaged the membership was … nearly one in every five rheumatologists [who were contacted to take the survey] took the time to give their input.”
This resulted in a list of 10 items that was referred back to the task force. A targeted literature review helped the task force select the final five items.