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April 2014

How Should Top-Five Lists Be Developed?What Is the Next Step?

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
  • 3Department of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles
JAMA Intern Med. 2014;174(4):498-499. doi:10.1001/jamainternmed.2013.8272

Readers might wonder why the editors of JAMA Internal Medicine decided to publish “A Top-Five List for Emergency Medicine.” Some of our readers might practice emergency medicine (EM), and many provide “urgent” care. However, we decided to publish this article for another reason.

We believe that “A Top-Five List for Emergency Medicine” from Schuur et al1 at Partners Healthcare demonstrates a solid methodological approach to developing a list of low-value tests, procedures, and treatments in response to the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. Although many professional societies have published “top-five” lists, most have not detailed the methods by which the list was created. In some cases, it is clear that the lists were developed without much input from frontline practitioners, using a process that was not transparent and without clear criteria for inclusion on the list. We hope the article by Schuur et al1 will stimulate other professional societies to adopt clear, transparent methods for developing and revising top-five lists with substantial input from practicing clinicians. We would like to see a consensus develop around criteria for choosing items on top-five lists. To start this conversation, we suggest that there should be clear evidence that the tests and treatments on a top-five list cause potential harm or provide little benefit to patients, are frequently misused in clinical practice, are measureable, and are under the control of providers.

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