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Research Letter
Less Is More
March 2018

An Examination of Deintensification Recommendations in Clinical Practice Guidelines: Stepping Up or Scaling Back?

Author Affiliations
  • 1VA Center for Clinical Management and Research, Ann Arbor, Michigan
  • 2University of Michigan Medical School, Ann Arbor, Michigan
  • 3Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
JAMA Intern Med. 2018;178(3):414-416. doi:10.1001/jamainternmed.2017.7198

By shaping physician behavior and performance measures, clinical practice guidelines could help or hinder efforts to balance overuse and underuse. This is especially critical for chronic conditions such as diabetes or cardiovascular disease, in which management must be continuously reevaluated as patient health, treatment goals, and medical knowledge evolve. While initiatives to decrease use of unnecessary services such as Choosing Wisely largely address 1-time services (eg, antibiotics for upper respiratory tract infections),1 most care involves ongoing testing or treatment decisions for chronic disease. Guidelines should therefore specify when to deintensify care—stopping or scaling back the intensity or frequency of routine services.2 To better understand the balance between overuse and underuse in current guidelines, we examined whether guidelines in 2 major clinical areas with well-developed guidelines preferentially recommend intensification rather than deintensification.