Glen Gillen, Elizabeth G. Hunter, Deborah Lieberman, Melissa Stutzbach; AOTA’s Top 5 Choosing Wisely® Recommendations. Am J Occup Ther 2019;73(2):7302420010p1-7302420010p9. doi: 10.5014/ajot.2019.732001.
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© 2019 American Occupational Therapy Association
Health care spending in the United States continues to grow at an unsustainable rate. In 2015, spending increased 5.8%, to reach $3.2 trillion, or $9,990 per person. As a share of the nation’s gross domestic product, health spending accounted for 17.8% (Morgan et al., 2016). A critical component of addressing this issue is eliminating wasteful spending without reducing quality and appropriate care. In 2012, Choosing Wisely®, an initiative of the ABIM Foundation (American Board of Internal Medicine), started with the aim to encourage meaningful conversations between health care practitioners and clients to ensure that appropriate and quality care is being provided. The American Occupational Therapy Association (AOTA) made a commitment to join Choosing Wisely in 2016. With support and input from AOTA members, the Board of Directors, and staff, AOTA implemented a three-phase process to develop and publish the list, “Five Things Patients and Providers Should Question.” The goal of AOTA’s participation in this initiative is to start dialogue within the occupational therapy profession about providing quality services that are supported by evidence, not duplicative, free from harm, and truly necessary.
Supported by evidence,
Not duplicative of other tests or procedures already received,
Free from harm, and
Support efforts to help clients make smart and effective health care choices,
Promote effective use of health care resources, and
Help improve the quality and safety of health care in the United States.
Inform clinical decision making to improve occupational therapy practice,
Leverage the value of occupational therapy interventions with external audiences,
Share with clients for informed decision making,
Provide foundational materials for academic and continuing education programs,
Guide the development of clinical research projects, and
Provide a valuable AOTA member benefit.
The service is relevant to occupational therapy practice and, if included on the list, would positively impact the profession and client care.
There is evidence to demonstrate that the service offers no benefit to most clients, and in some circumstances may be harmful.
The service is not cost effective.
The service is not truly necessary.
The service is not duplicative of other services already received.
“Provide appropriate evaluation and a plan of intervention for recipients of occupational therapy services specific to their needs.” (p. 2)
“Use, to the extent possible, evaluation, planning, intervention techniques, assessments, and therapeutic equipment that are evidence based, current, and within the recognized scope of occupational therapy practice.” (p. 2)
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