National Choosing Wisely campaign adopts MEDIC quality measure

The Michigan Emergency Data Improvement Collaborative* Collaborative Quality Initiative has been recognized by the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. It adopted the MEDIC measure “Reducing CXR utilization in children with minor respiratory conditions (asthma, bronchiolitis and croup)” in December 2022.

More about the measure

Respiratory illnesses are among the top 10 diagnoses for which children visit an emergency department — and asthma, bronchiolitis and croup are the most common pediatric respiratory illnesses. According to MEDIC, medical evidence suggests that chest X-rays are frequently used by emergency providers in children presenting for these conditions, yet they rarely reveal information that leads to changes in how the conditions are managed.

Several studies also reveal significant variation in chest X-ray use in asthma, bronchiolitis and croup. This occurs both in children’s hospitals and general emergency departments, with higher utilization rates in the latter.

“We are very pleased to see these guidelines developed by MEDIC physician leaders in collaboration with the Michigan emergency department physician community receive national validation via the Choosing Wisely adoption of the measure,” said Tom Leyden, director, Value Partnerships. “The literature shows a longstanding history of X-rays being taken at times when they’re not always clinically indicated for diagnosis and/or treatment. Addressing this issue in the ongoing treatment of children in the ER for common conditions is so very important.”

Guidelines for chest X-ray use are available through the American Academy of Pediatrics and the medical literature for these conditions. The guidelines have been endorsed as a Choosing Wisely recommendation by the American Academy of Pediatrics Section on Emergency Medicine and the Canadian Association of Emergency Physicians.

More about Choosing Wisely

In April 2012, the American Board of Internal Medicine Foundation, along with Consumer Reports, formally launched the Choosing Wisely* campaign with the release of “Top Five” lists from nine specialty societies. Currently, more than 70 societies comprising more than 1 million clinicians are now partners of the Choosing Wisely campaign.

Choosing Wisely’s goal is to help patients choose care that is:

• Supported by evidence
• Not duplicative of other tests or procedures already received
• Free from harm
• Truly necessary

More about MEDIC

MEDIC catalyzes clinical practice change where there is strong evidence and opportunity to improve quality of care for children and adults visiting emergency departments across the state of Michigan. Participants use the MEDIC data registry to collaborate to improve population health, increase health equity in emergency medicine and address social determinants of health.

MEDIC has resulted in:

• 5,000 chest X-rays avoided in children with asthma, croup, or bronchiolitis
• 11,000 chest CT scans avoided in adults with suspected pulmonary embolism
• 8,000 head CT scans avoided in adults and children with minor head injury
• 875 hospital admissions avoided for adults with low-risk chest pain

The collaborative is managed by the MEDIC Coordinating Center, which is housed at the University of Michigan. Support for MEDIC is provided by Blue Cross Blue Shield of Michigan and Blue Care Network as a part of our Value Partnerships program. To learn more about Value Partnerships, visit valuepartnerships.com.

*Blue Cross Blue Shield of Michigan doesn’t own or control this website.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.