EVOLVE: The Australian Rheumatology Association's 'top five' list of investigations and interventions doctors and patients should question

Kathleen Morrisroe; Ayano Nakayama; Jason Soon; Mark Arnold; Les Barnsley; Claire Barrett; Peter M Brooks; Stephen Hall; Patrick Hanrahan; Pravin Hissaria; Graeme Jones; Veera S Katikireddi; Helen Keen; Rodger Laurent; Mandana Nikpour; Katherine Poulsen; Philip Robinson; Muriel Soden; Nigel Wood; Nicola Cook; Catherine Hill; Rachelle Buchbinder

doi:10.1111/imj.13654

EVOLVE: The Australian Rheumatology Association's 'top five' list of investigations and interventions doctors and patients should question

Intern Med J. 2018 Feb;48(2):135-143. doi: 10.1111/imj.13654.

Authors

Kathleen Morrisroe^{1

2}, Ayano Nakayama^{3

4}, Jason Soon^{5

6}, Mark Arnold⁷, Les Barnsley⁸, Claire Barrett⁹, Peter M Brooks¹⁰, Stephen Hall¹¹, Patrick Hanrahan¹², Pravin Hissaria¹³, Graeme Jones¹⁴, Veera S Katikireddi¹⁵, Helen Keen^{12

16}, Rodger Laurent¹⁷, Mandana Nikpour^{1

2}, Katherine Poulsen¹⁵, Philip Robinson¹⁸, Muriel Soden^{19

20}, Nigel Wood²¹, Nicola Cook²², Catherine Hill²³, Rachelle Buchbinder^{24

25}

Affiliations

¹ Department of Rheumatology, St Vincent's Hospital, Sydney, New South Wales, Australia.
² Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
³ Rheumatology Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
⁴ College of Medicine, Biology and Environment, Australian National University, Canberra, Australian Capital Territory, Australia.
⁵ Royal Australasian College of Physicians, Sydney, New South Wales, Australia.
⁶ Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
⁷ School of Rural Health, University of Sydney, Sydney, New South Wales, Australia.
⁸ Department of Rheumatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
⁹ Department of Rheumatology, Redcliffe Hospital, Brisbane, Queensland, Australia.
¹⁰ Centre for Health Policy, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
¹¹ Department of Medicine, Monash University and Cabrini Health, Melbourne, Victoria, Australia.
¹² Department of Medicine, University of Western Australia, Perth, Western Australia, Australia.
¹³ Department of Immunology, SA Pathology, Clinical Immunology Unit, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia.
¹⁴ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
¹⁵ Department of Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia.
¹⁶ Department of Rheumatology, Royal Perth Hospital and Fiona Stanley Hospital, Perth, Western Australia, Australia.
¹⁷ Department of Rheumatology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁸ School of Medicine, Royal Brisbane Hospital, University of Queensland, Brisbane, Queensland, Australia.
¹⁹ Department of Rheumatology, The Townsville Hospital, Townsville, Queensland, Australia.
²⁰ College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
²¹ Department of Rheumatology, University Hospital Geelong, Geelong, Victoria, Australia.
²² Department of Rheumatology, Royal Perth Hospital, Perth, Western Australia, Australia.
²³ Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia.
²⁴ Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Victoria, Australia.
²⁵ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

PMID: 29080286
DOI: 10.1111/imj.13654

Abstract

Background: The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices.

Aims: To determine the Australian Rheumatology Association's (ARA) 'top five' list of low-value practices.

Methods: A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top five' list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016).

Results: A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order anti-nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%); Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%) and Do not order anti-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%).

Conclusions: This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.

Keywords: EVOLVE; evidence-based practice; implementation; low-value care; rheumatology.

MeSH terms

Australia / epidemiology
Diagnostic Tests, Routine / methods
Diagnostic Tests, Routine / standards*
Early Medical Intervention / methods
Early Medical Intervention / standards*
Female
Humans
Male
Physicians / standards*
Practice Guidelines as Topic / standards*
Rheumatic Diseases / diagnosis*
Rheumatic Diseases / epidemiology
Rheumatic Diseases / therapy
Rheumatology / methods
Rheumatology / standards*