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. 2021 Sep 27;181(11):1490–1500. doi: 10.1001/jamainternmed.2021.5531

Table 1. Low-Value Service Measure Descriptions.

Category and key No. Label Description
Laboratory testing
1a Preoperative laboratory testing Do not perform baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery
2a PSA testing Do not perform PSA-based screening for prostate cancer in men older than 70 years
3a 25-Hydroxy vitamin D testing Do not perform population-based screening for 25-hydroxy-vitamin D deficiency
4 Testing for chronic urticaria Do not routinely do diagnostic testing in patients with chronic urticaria
5a Immunoglobulin G or E testing Do not perform unproven diagnostic tests, such as immunoglobulin G testing or an indiscriminate battery of immunoglobulin E tests, in the evaluation of allergy
6 Bleeding time testing Do not use bleeding time testing to guide patient care
Imaging
7a Imaging for eye disease Do not routinely order imaging tests for patients without symptoms or signs of significant eye disease
8a Short-interval repeat DEXA scan Do not routinely repeat DEXA scans more often than once every 2 years
9a Imaging for headache Do not perform imaging for uncomplicated headache
10a Carotid artery imaging for simple syncope Do not perform imaging of the carotid arteries for simple syncope without other neurologic symptoms
11a Head imaging for syncope Do not obtain brain imaging studies (CT scans or MRI) in the evaluation of simple syncope and a normal neurologic examination
12a Emergency department head CT scan for dizziness Do not perform routine head CT scans for emergency department visits for dizziness
13a Imaging for low back pain Do not perform imaging for low back pain within the first 6 weeks unless red flags are present
14a Head CT scan for sudden hearing loss Do not order CT scan of the head or brain for sudden hearing loss
15a Imaging for uncomplicated acute rhinosinusitis Do not routinely perform radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis
16 MRI for rheumatoid arthritis Do not perform MRI of the peripheral joints to routinely monitor inflammatory arthritis
17 Coronary artery calcium scoring for known CAD Do not use coronary artery calcium scoring for patients with known CAD (including stents and bypass grafts)
18 DEXA scan in low-risk patients Do not use DEXA screening for osteoporosis in women younger than 65 years or men younger than 70 years with no risk factors
Cardiopulmonary and neurologic testing
19a Screening ECGs Do not order annual ECGs or any other cardiac screening for low-risk patients without symptoms
20a Preoperative ECG, chest radiographs, or PFT Do not perform ECGs, chest radiographs, or PFT in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery
21a EEG for headaches Do not perform EEG for headaches
22a Cardiac stress testing Do not perform stress cardiac imaging or advanced noninvasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present
23 PFT prior to cardiac surgery Do not recommend PFT prior to cardiac surgery in the absence of respiratory symptoms
24 Preoperative echocardiography or cardiac stress testing Do not perform baseline diagnostic cardiac testing or cardiac stress testing in asymptomatic stable patients with known cardiac disease undergoing low- or moderate-risk noncardiac surgery
Procedures
25a Cervical cancer screening Do not order unnecessary cervical cancer screening (Papanicolaou test and human papillomavirus test) in all women who have had adequate prior screening and are not otherwise at high risk for cervical cancer
26a Injection for low back pain Do not provide outpatient epidural, facet, or trigger point spinal injections for low back pain
27a Repeat short-interval colorectal cancer screening Do not order unnecessary screening for colorectal cancer in adults older than 50 years
28a Peripheral access placement without nephrology consultation in stage III-V CKD Do not place peripherally inserted central catheters in patients with stage III-V CKD without consulting nephrology
29 Feeding tubes for patients with dementia Do not recommend percutaneous feeding tubes for patients with advanced dementia
30a PCI for asymptomatic patients Avoid PCI for stable, asymptomatic patients with normal or only mildly abnormal adequate stress test results
31a Vertebroplasty for osteoporotic fractures Do not perform vertebroplasty for osteoporotic vertebral fractures
32a Coronary angiography in low-risk patients Do not perform coronary angiography in patients without cardiac symptoms unless high-risk markers are present
33 Multiple palliative radiotherapy treatments for bone metastases Do not recommend more than a single fraction of palliative radiotherapy for an uncomplicated painful bone metastasis
34 Renal artery revascularization Do not perform revascularization without prior medical management for renal artery stenosis
35 Arthroscopic lavage and debridement for knee osteoarthritis Do not perform an arthroscopic knee surgery for knee osteoarthritis
Drugs
36a Antipsychotics for patients with dementia Do not use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia
37a Opiates for acute disabling low back pain Do not prescribe opiates for acute disabling low back pain before evaluation and a trial of other alternatives is considered
38a Antibiotics for acute upper respiratory tract and ear infections Do not prescribe oral antibiotics for patients with upper respiratory tract or ear infection (acute sinusitis, viral respiratory illness, or acute otitis externa)
39 Antibiotics for adenoviral conjunctivitis Do not order antibiotics for adenoviral conjunctivitis
40 Antidepressant monotherapy for bipolar disorder Do not prescribe antidepressants as monotherapy for patients with bipolar I disorder
41a Two or more concurrent antipsychotic medications Do not routinely prescribe 2 or more antipsychotic medications concurrently

Abbreviations: ASA I or II, American Society of Anesthesiologists Physical Status Classification I or II; CAD, coronary artery disease; CKD, chronic kidney disease; CT, computed tomography; DEXA, dual-energy x-ray absorptiometry; ECG, electrocardiogram; EEG, electroencephalography; MRI, magnetic resonance imaging; PCI, percutaneous coronary intervention; PFT, pulmonary function testing; PSA, prostate-specific antigen.

a

Measures included in the main composite score. Measures with key numbers 8, 26, 29, 30, and 36 were not derived from the Milliman MedInsight Health Waste Calculator. Descriptions are adapted from Choosing Wisely and US Preventive Services Task Force recommendations.