Choosing wisely: The American College of Rheumatology's top 5 list of things physicians and patients should question

Jinoos Yazdany, Gabriela Schmajuk, Mark Robbins, David Daikh, Ashley Beall, Edward Yelin, Jennifer Barton, Adam Carlson, Mary Margaretten, Joann Zell, Lianne S. Gensler, Victoria Kelly, Kenneth Saag, Charles King

Research output: Contribution to journalArticlepeer-review

70 Scopus citations


Objective We sought to develop a list of 5 tests, treatments, or services commonly used in rheumatology practice whose necessity or value should be questioned and discussed by physicians and patients. Methods We used a multistage process combining consensus methodology and literature reviews to arrive at the American College of Rheumatology's (ACR) Top 5 list. Rheumatologists from diverse practice settings generated items using the Delphi method. Items with high content agreement and perceived high prevalence advanced to a survey of ACR members, who comprise >90% of the US rheumatology workforce. To increase the response rate, a nested random sample of 390 rheumatologists received more intensive survey followup. The samples were combined and weighting procedures were applied to ensure generalizability. Items with high ratings underwent literature review. Final items were then selected and formulated by the task force. Results One hundred five unique items were proposed and narrowed down to 22 items during the Delphi rounds. A total of 1,052 rheumatologists (17% of those contacted) participated in the member-wide survey, whereas 33% of those in the nested random sample participated; respondent characteristics were similar in both samples. Based on survey results and available scientific evidence, 5 items (relating to antinuclear antibodies, Lyme disease, magnetic resonance imaging, bone absorptiometry, and biologic therapy for rheumatoid arthritis) were selected for inclusion. Conclusion The ACR Top 5 list is intended to promote discussions between physicians and patients about health care practices in rheumatology whose use should be questioned and to assist rheumatologists in providing high-value care.

Original languageEnglish (US)
Pages (from-to)329-339
Number of pages11
JournalArthritis Care and Research
Issue number3
StatePublished - Mar 2013
Externally publishedYes

ASJC Scopus subject areas

  • Rheumatology


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