TY - JOUR T1 - Choosing Wisely: The Canadian Rheumatology Association’s List of 5 Items Physicians and Patients Should Question JF - The Journal of Rheumatology JO - J Rheumatol SP - 682 LP - 689 DO - 10.3899/jrheum.141140 VL - 42 IS - 4 AU - Shirley L. Chow AU - J. Carter Thorne AU - Mary J. Bell AU - Robert Ferrari AU - Zarnaz Bagheri AU - Tristan Boyd AU - Ann Marie Colwill AU - Michelle Jung AU - Damian Frackowiak AU - Glen S. Hazlewood AU - Bindee Kuriya AU - Peter Tugwell Y1 - 2015/04/01 UR - http://www.jrheum.org/content/42/4/682.abstract N2 - Objective. To develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients. Methods. Using the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items. Results. Sixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review. Conclusion. The list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care. ER -