The authors found a significant difference in health outcomes and costs between the two groups. For patients whose physicians did not follow the alerts, the odds of complications increased by 29 percent compared to the group whose physicians followed the alerts. Likewise, the odds of hospital readmissions within 30 days of the patients’ original visits was 14 percent higher in the group whose physicians did not follow the alerts. Patients of these physicians also saw a 6.2 percent increase in their length of stay and an additional 7.3 percent – or $944 per patient – in costs, after adjusting for differences in patient illness severity and case complexity.

“Sometimes doctors order tests that they think are in the patient’s best interest, when research doesn’t show that to be the case. Unnecessary testing can lead to interventions that can cause harm,” said Harry C. Sax, MD, executive vice chair of Surgery at Cedars-Sinai and a senior author of the study. “This work is about giving the right care that patients truly need.”


The authors acknowledge limitations to the study. Their strict definition of alert compliance, which excluded visits in which physicians followed some but not all alerts, limited their understanding of the clinical and financial impact of those visits. Additionally, the investigators were unable to measure the impact of specific alerts on outcomes to see if one alert was more significant than others. Finally, it is possible that physicians with better patient outcomes and lower costs are more likely to follow Choosing Wisely clinical decision support alerts, rather than proving a “cause and effect” relationship between following the alerts and better outcomes.

Disclosures: Optum is a licensed reseller of Stanson Health, including its Choosing Wisely alert content evaluated in this study. Cedars-Sinai is the major shareholder of Stanson Health and employs the company’s founders, Darren Dworkin, Cedars-Sinai chief information officer and stockholder of Stanson Health, and Weingarten, who is chairman of the board and stockholder of Stanson Health.


About Cedars-Sinai
Cedars-Sinai is a leader in providing high-quality healthcare encompassing primary care, specialized medicine and research. Since 1902, Cedars-Sinai has evolved to meet the needs of one of the most diverse regions in the nation, setting standards in quality and innovative patient care, research, teaching and community service. Today, Cedars-Sinai is known for its national leadership in transforming healthcare for the benefit of patients. Cedars-Sinai impacts the future of healthcare by developing new approaches to treatment and educating tomorrow’s health professionals. Additionally, Cedars-Sinai demonstrates a commitment to the community through programs that improve the health of its most vulnerable residents.

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