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ASCP’s 10-year involvement in the ABIM Foundation’s Choosing Wisely campaign has helped put the national spotlight on effective test utilization. With the Choosing Wisely initiative now over, ASCP’s test utilization initiatives will be folded into the work of its Quality and Patient Safety Steering Committee.  

“The Choosing Wisely campaign has had a big impact,” says Elise Occhipinti, MD, Chair of ASCP’s Quality and Patient Safety Steering Committee, adding, “Nationally, my experience is that health professionals have been very interested in test utilization. Whenever I give talks at a national meeting, any sessions on test utilization are well attended, particularly among the laboratory community. In the overall community of healthcare, people are becoming more interested as we switch to value-based care from volume-based care.”  

Dr. Occhipinti has been a champion for test utilization since 2014 and has served on various iterations of test utilization committees at Ochsner Health System, her employer, for the past decade. In addition to serving as Chair of the ASCP Quality and Patient Safety Steering Committee, she also currently chairs Ochsner’s Care Variation Committee.   

“The north star is to reduce variation in care, which may mean having a certain way in which you work up a diagnosis by only using laboratory testing that is valid and meaningful,” she says. “We really use Choosing Wisely as our framework. The reason why our committee has been successful is that it comprises a multidisciplinary team.” Under the Choosing Wisely program, each year, ASCP compiled the most relevant testing questions and protocol improvements developed by the Choosing Wisely community to develop a reference guide of Choosing Wisely recommendations. Although the ABIM Foundation discontinued the Choosing Wisely program, ASCP is continuing to prioritize our focus on effective test utilization recommendations and supporting the entire laboratory test stewardship community.” 

Dr. Occhipinti said one of the biggest lessons she has learned over the past decade is that merely publishing a list of recommended tests to review is not going to automatically get clinicians to change their test ordering processes. 

“We need to give clinicians the tools to implement the recommendations. Healthcare resources are very scarce in every hospital,” she says. “If you are passionate about appropriate test ordering, you must figure out a way to get others in your system to see the value in it. If you are going to put resources in this area, you are taking away resources that you could invest in another area. We have to give people the tools, whether that is operational support or change management. We need to present a compelling story as to why these changes are needed. Then, we need to collaborate with our clinician colleagues. We also need to understand that perhaps the clinicians are ordering certain tests for a reason that we have not explored or that they fear missing something and not serving their patients correctly.”   

ASCP continues to utilize test utilization data from the National Pathology Quality Registry (NPQR) to examine trends in physician test ordering. Dashboards are currently being refined to provide a real-time tool that laboratories can use to implement and monitor test utilization initiatives. 

Collaboration brings complementary strengths 

The American Society for Microbiology (ASM) and the American Society for Clinical Laboratory Science (ASCLS) have partnered with ASCP on Choosing Wisely recommendations in the past and will continue their collaboration under the new structure.  

“The American Society for Microbiology strives to provide up-to-date accurate clinical microbiology information to its members,” says Paige M. K. Larkin, PhD, D(ABMM), M(ASCP)CM, the ASM’s Program Officer for Clinical Microbiology. “By collaborating with ASCP through the effective test utilization (ETU) initiative, ASM has continued to develop a series of microbiology best practices based on literature and established guidelines to support testing that improves patient care.”  

Looking ahead, ASCP will continue its efforts to gain buy-in from laboratories and health systems across the country for this effort. As ASCP moves forward in test utilization, it also aims to expand its collaborations to include additional specialty healthcare societies.  

Through the ASCP effective test utilization best practices program, ASCP members, staff, and partner organizations, strive to not only help pathologists and laboratory professionals make decisions about appropriate testing and patient care, but to implement and operationalize those recommendations in the laboratory and throughout the systems in which ASCP members practice.  

“The Choosing Wisely recommendations we put out are widely used to influence test utilization initiatives on the front lines of laboratories,” says ASCP Chief Medical Officer Ali Brown, MD, FASCP. “They are practical, broadly applicable and backed by science and expert consensus. This is exactly what labs need to make an impact on ordering providers’ behavior. There was widespread surprise when ABIM Foundation announced that it was sunsetting the program because of the tremendous value it has brought to our patients. ASCP intends to continue this important lab-directed initiative.” 

ASM’s Dr. Larkin agreed that the Choosing Wisely recommendations have had an important impact on her organization’s work. “Clinical microbiology laboratories can use the test utilization measures to guide test offerings,” she says. “The recommendations provide support for making changes in algorithms, discontinuing outdated practices, and implementing new assays or improved stewardship measures.”  

Dawn Rudnik, MLS(ASCP)SM, a volunteer with ASCLS, says there are advantages to collaborating with a larger organization such as ASCP.  

“ASCLS is a smaller society than ASCP,” says Ms. Rudnik, who retired in January as laboratory manager at the University of Michigan Health Service, in Ann Arbor, MI. “What we struggle with is how to get the message out beyond our own small membership about the tests we have recommended for inclusion on the test utilization list.”   

ASCLS’ members include many educators with expertise in medical laboratory science, hematology, clinical chemistry, blood bank, molecular science, and microbiology. Often, when working in the laboratory, an ASCLS member will review a clinician’s test order and question why a certain test was ordered.   

“Their expertise is very targeted,” Dr. Occhipinti notes. “If, for example, I have a question about microbiology testing, I’m going to ask ASM. They know how these types of tests perform. They probably know who developed the test, and the history behind it. So, why reinvent the wheel? Let’s partner with them.” 

Conversely, ASCP is a much larger organization in terms of staff and membership; it has a diverse membership comprising both laboratory professionals and pathologists; and it has a strong ability to advocate for its members at the national level. During the Choosing Wisely campaign, ASCP worked with ASCLS and ASM to disseminate their test utilization recommendations in a robust fashion, using its various journals, online articles, social media, and emails, as well as through webinars and Annual Meeting education sessions.  

Ms. Rudnik says the vetting process ran very smoothly during the Choosing Wisely campaign. At ASCLS, recommendations were brought to the Choosing Wisely (CW) Committee via committee members as well as from other ASCLS members outside of the committee. After the Choosing Wisely Committee reviewed and commented on the proposed recommendations, it forwarded the recommendations on to ASCLS’ specific scientific assemblies for further review. Once the recommendations were fully vetted, the final drafts were forwarded on to the Choosing Wisely Board of Directors for final approval. 

“Previously, there were several recommendations that we partnered on with ASCP, and they reviewed them as well before the final drafts were sent to ABIM,” Ms. Rudnik says. "Going forward, ASCLS plans to combine our Choosing Wisely work with our Patient Safety Committee. We are still working out how this new combined committee will look. We do know that we want to continue our collaboration with ASCP and their Effective Test Utilization effort." 

“Working together so closely requires that all of the partners need to develop a sense of trust,” adds Dr. Occhipinti. “ASCP needs to get the message out that we are the experts in this area, and we need to bring this guideline that not only serves our patient but our system as well.” 

Test utilization efforts forge ahead  

ASCP’s success with its Choosing Wisely program and its partner organizations served as a launchpad from which to address the issue of test over-utilization across many facets of the healthcare industry. It developed a successful framework in which to suggest and review potential recommendations, and it sparked conversations between clinicians and patients about what tests, treatments, and procedures are needed.  

“The ABIM Foundation’s Choosing Wisely campaign was really the catalyst to get this conversation started and to put the framework for vetting recommendations in place,” says ASCP Chief Medical Officer Ali Brown, MD, FASCP. “It was highly successful. ASCP is ready to take it from there.”   

“We will continue to accept and vet new recommendations under the effective test utilization best practices campaign,” Dr. Brown says. “ASCP is also moving toward an expanded focus where we will look at the implementation of practical tools and programs that laboratories across the country can use in their own utilization initiatives.” 

Call for recommendations 

ASCP is accepting nominations from pathologists and laboratory professionals of tests that you believe should be considered for inclusion in ASCP’s Effective Test Utilization Best Practices initiative. The ASCP lists of tests that should be questioned are developed under the leadership of the ASCP Center for Quality and Patient Safety. The deadline for submissions is March 31, 2024. For a list of criteria and more detailed description, click here. 

To learn more about ASCP’s ongoing work in effective test utilization, please contact Liz Waibel at liz.waibel@ascp.org.