Measuring the Effectiveness of Choosing Wisely Campaign on Laboratory Testing for Hospitalized Patients


      Since the start of the Choosing Wisely Campaign (CWC) in 2012, there have been multiple interventions to curb unnecessary laboratory testing. However, no study has examined the impact of the CWC on laboratory tests in an inpatient setting. The objective of this study was to determine if the CWC is associated with a decrease in the number of laboratory tests performed during hospitalization.


      A retrospective study was conducted at a tertiary care academic hospital using data from January 2008 through September 2018. Data on age, gender, race, length of stay, and the date of common laboratory tests were collected. Data were categorized into pre-campaign (2008–2010), early-campaign (2013–2015), and late-campaign (2016–2018) periods.


      Of the 10,510,491 labs, 4,637,250 (44.1%) were performed on females, and 5,005,847 (47.6%) on African Americans. The mean (standard deviation [SD]) age of the total population was 51.7 (17.9) years, and the length of hospitalization was 6.3 (9.1) days. Using generalized linear models, the researchers found that overall laboratory tests increased by 8.6% in the late-campaign compared with the pre-campaign period (adjusted p < 0.0001). The percentage changes translate into the following number of additional tests per 100 patient-days during the late-campaign period compared with the pre-campaign period: sodium 8.6, potassium 7.9, hemoglobin 7.1, creatinine 7.1, magnesium 3.9, and alanine transferase 2.4.


      The findings of this study, if validated by data from other institutions, will suggest the need for better implementation strategies for high-value care. Future research exploring an effective strategy for delivering high-value care is needed.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Joint Commission Journal on Quality and Patient Safety
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Poisal JA
        • et al.
        National health expenditure projections, 2021-30: growth to moderate as COVID-19 impacts wane.
        Health Aff (Millwood). 2022; 41: 474-486
      1. Congress of the United States, Congressional Budget Office: The long-term outlook of health care spending. Nov 2007. Accessed July 7, 2022.

      2. Congress of the United States, Congressional Budget Office: The 2020 Long-Term Budget Outlook. Sep 2020. Accessed Jun 28, 2022.

        • Institute of Medicine
        The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary.
        National Academies Press, Washington, DC2010
      3. PerryUndem Research/Communication. Unnecessary Tests and Procedures in the Health Care System: What Physicians Say About the Problem, the Causes, and the Solutions: Results from a National Survey of Physicians. May 1, 2014. Accessed Jun 28, 2022.

        • Bulger J
        • et al.
        Choosing Wisely in adult hospital medicine: five opportunities for improved healthcare value.
        J Hosp Med. 2013; 8: 486-492
        • ABIM Foundation
        Choosing Wisely®: Promoting Conversations Between Patients and Clinicians.
        Accessed. Jun 28, 2022;
        • Cassel CK
        • Guest JA.
        Choosing Wisely: helping physicians and patients make smart decisions about their care.
        JAMA. 2012 May 2; 307: 1801-1802
        • Iams W
        • et al.
        A multidisciplinary housestaff-led initiative to safely reduce daily laboratory testing.
        Acad Med. 2016; 91: 813-820
        • Tawfik B
        • et al.
        House officer–driven reduction in laboratory utilization.
        South Med J. 2016; 109: 5-10
        • Feldman LS
        • et al.
        Impact of providing fee data on laboratory test ordering: a controlled clinical trial.
        JAMA Intern Med. 2013 May 27; 173: 903-908
        • Brown SR
        • Brown J.
        Why do physicians order unnecessary preoperative tests? A qualitative study.
        Fam Med. 2011; 43: 338-343
      4. Mirakov Cohen JI, et al. Don't Bleed: A High Value Care Initiative to Decrease Diagnostic Phlebotomy. Accessed Jun 28, 2022.

        • Bishop TF
        • et al.
        Academic physicians’ views on low-value services and the Choosing Wisely campaign: a qualitative study.
        Healthc (Amst). 2017; 5: 17-22
        • Maughan BC
        • et al.
        Choosing Wisely in emergency medicine: a national survey of emergency medicine academic chairs and division chiefs.
        Acad Emerg Med. 2015; 22: 1506-1510
        • Colla CH
        • Mainor AJ.
        Choosing Wisely campaign: valuable for providers who knew about it, but awareness remained constant, 2014–17.
        Health Aff (Millwood). 2017; 36: 2005-2011
        • Colla CH
        • et al.
        Interventions aimed at reducing use of low-value health services: a systematic review.
        Med Care Res Rev. 2017; 74: 507-550
        • Zare S
        • et al.
        Laboratory test ordering in inpatient hospitals: a systematic review on the effects and features of clinical decision support systems.
        BMC Med Inform Decis Mak. 2021 Jan 18; 21: 20
        • Rubinstein M
        • et al.
        Effectiveness of practices to support appropriate laboratory test utilization: a laboratory medicine best practices systematic review and meta-analysis.
        Am J Clin Pathol. 2018 Feb 17; 149: 197-221