ASCP Choosing Wisely: 10 Years of Making a Difference for Improving Patient Care

In 1922, pathology as a medical specialty created its national organization, the American Society for Clinical Pathologists. Its objectives included promoting the practice of medicine through the application of clinical laboratory methods; stimulating original research; establishing uniform standards for laboratory tests; elevating the professional status of those practicing laboratory medicine; and encouraging collaboration with their colleagues in other branches of medicine. Now ASCP, the American Society for Clinical Pathology, celebrates 100 years providing excellence in education, certification, and advocacy on behalf of patients, pathologists and laboratory professionals.

Central to ASCP’s mission, therefore, is ensuring that laboratory services are appropriately used, reducing or eliminating overuse, underuse and misuse of services. That’s why ASCP continued its series of firsts by being among the initial specialty societies to join Choosing Wisely, the American Board of Internal Medicine’s program to promote conversations between clinicians and patients by helping patients choose care that is: supported by evidence, not duplicative of other tests or procedures already received, free from harm, and truly necessary.

ASCP has been working with Choosing Wisely for a decade now and our members have been among the most active participants in the program. Led by ASCP’s Effective Test Utilization Committee, ASCP has developed 39 recommendations that focus on common challenges we see in laboratory practice:

• Tests with merit in some circumstances but are not appropriate in others
• Tests with little or no clinical utility
• Tests that have been generally replaced by better tests
• New and emerging diagnostics

Pathology and laboratory medicine advancing appropriate utilization in the medical community

The ASCP Effective Test Utilization 10-Year Report presents a detailed summary of the ASCP’s Effective Test Utilization Steering Committee’s (ETUSC) work to support the ASCP’s Choosing Wisely Initiative and its impact over the past decade (2012-2022). To achieve its mission, the ETUSC works with individuals and groups from the field of pathology and laboratory medicine and the healthcare community at large; partner organizations; and industry.

Since ASCP joined the ABIMF’s Choosing Wisely campaign in 2012, many of our members and non-members have been working to advance its ideals, which are intended to reduce test overuse and encourage clinicians and patients to question which tests are really necessary. As one of 80 medical societies in the Choosing Wisely campaign, ASCP is the only society representing pathology and laboratory medicine. Our goal is to identify the right test at the right time for the right cost to better serve our patients and improve the nation’s healthcare system. In the past 10 years, ASCP has supported the Choosing Wisely campaign by advancing its major activities: creation of list of recommendations and the Choosing Wisely Champions.

Each year, ASCP compiles the most relevant testing questions and protocol improvements developed by the Choosing Wisely community to develop a reference guide of Choosing Wisely Recommendations. These recommendations help pathologists and laboratory professionals make decisions about appropriate testing and patient care. The ASCP list of recommendations are developed under the leadership of the ASCP Effective Test Utilization Steering Committee. This committee is chaired by an ASCP Past President and is comprised of subject matter and test utilization experts along with 737 advisory board members across the fields of pathology and laboratory medicine.

The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly, and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs and a more effective use of our laboratory resources and personnel. ASCP has since released seven lists of recommendations and four special SARS-CoV-2 recommendations, bringing the total to 39 recommendations. While the focus of our lists is on overused tests, the ASCP also provides guidance regarding test selection. The Choosing Wisely recommendations can form the basis of Laboratory Stewardship programs focused on evidence-based, effective test utilization strategies.

The Choosing Wisely Champions program, launched by the ABIM Foundation in 2016, was created to recognize clinicians who are leading efforts to reduce overuse and waste in medicine. Since participating in the program, the ASCP have chosen 35 Champions who have advanced appropriate test utilization in their health systems and demonstrated leadership of a local Choosing Wisely effort. “The Choosing Wisely Champions program seeks to recognize individual clinicians for their contributions to the campaign, inspire clinicians seeking to implement Choosing Wisely in their own practice, and demonstrate how clinicians are driving change in healthcare,” said Lee H. Hilborne, MD, MPH, DLM(ASCP)^CM, FASCP, Chair, ASCP Effective Test Utilization Subcommittee. “Clinicians can learn from one another by highlighting exemplars.”

Lastly, the work of the ASCP Choosing Wisely team resulted in ASCP being the first society to promulgate 39 recommendations; collaborated with the National Kidney Foundation (NKF) to address Chronic Kidney Disease by promoting an updated “Kidney Profile” test with a Laboratory Engagement Plan since 2017; partnered with the American Society for Clinical Laboratory Science (ASCLS) and the American Society for Microbiology (ASM) Partnerships on Choosing Wisely; ASCP recommendations Vitamin-D testing and preoperative testing for low risk surgeries were cited by the ABIM Foundation as two of the Choosing Wisely recommendations that drove the largest decrease in unnecessary tests and procedures; and publication of the article, Non-ASCP Choosing Wisely Recommendations Relevant to Pathology and Laboratory Medicine.

Lee H. Hilborne, MD, MPH, FASCP, DLM(ASCP)^CM
Chair
Quest Diagnostics Senior Medical Director, Medical Affairs UCLA Health System Medical Director, Care Coordination Professor of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA

Dana Altenburger, MD, FASCP, FCAP
Medical Director, Laboratory and Blood Bank at Carle BroMenn Medical Center

Geoffrey Baird, MD, PhD
Acting chair of Laboratory Medicine, an associate professor of Laboratory Medicine and an adjunct associate professor of Pathology, University of Washington

Alexandra Brown, MD, FASCP
Medical Director, National Pathology Quality Registry, American Society for Clinical Pathology

Barbara Caldwell, MS, MASCP, MLS (ASCP)^CM, SH^CM
Medical Laboratory Scientist, Consultant

Lynnette G. Chakkaphak, MS, MT(ASCP)
System Laboratory Director, St. Vincent’s HealthCare; Director, Consolidated Laboratory Services, Jacksonville, Florida

Jessie Conta, MS, LCGC
Laboratory Genetic Counselor, Supervisor
Department of Laboratories, Seattle Children’s; Director of Genetic Counseling Services, PLUGS (Patient-centered Laboratory Utilization Guidance Services)

William G. Finn, MD, MASCP
Partner, Integrated Health Associates
Medical Director, Warde Medical Laboratory
Adjunct Professor of Pathology, University of Michigan, Ann Arbor, MI

Diana Kremitske, MS, MHA, MT(ASCP)
Vice President Laboratory Operations
Geisinger Health System, PA

Steven H. Kroft, MD, MASCP
Professor and Chair of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin

Elise Occhipinti, MD
Chair, Clinical Pathology, Ochsner, Jefferson Highway; Laboratory Medical Director, Ochsner Jefferson Highway; Staff Hematopathologist, Ochsner Health System

Gary W. Procop, MD, MS, MASCP
CEO, American Board of Pathology; Ex-Officio

Gregory Sossaman, MD, MASCP
Chairman, Department of Pathology and Laboratory Medicine, Ochsner Clinic Foundation; Past Member (2012-2021)

Edna Garcia, MPH
Senior Director, Scientific Engagement and Research, ASCP ETUSC Staff Liaison

Jeff Jacobs, MA
Chief Officer, Science, Technology and Policy

Iman Kundu, MPH
Senior Manager, Research and Analytics

References

1. ASCP Effective Test Utilization 10-Year Report: https://ascpcdn.s3.amazonaws.com/static/Choosing+Wisely/CW_10-YearReport_web.pdf