• Shirley L Chow, J Carter Thorne, Mary J Bell, Robert Ferrari, Zarnaz Bagheri, Tristan Boyd, Ann Marie Colwill, Michelle Jung, Damian Frackowiak, Glen S Hazlewood, Bindee Kuriya, Peter Tugwell, and Canadian Rheumatology Association Choosing Wisely Committee.
• From the Division of Rheumatology, Department of Medicine, University of Toronto, Toronto; Southlake Regional Health Centre, Newmarket; Division of Rheumatology, Department of Medicine, Western University, London; Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, Ontario; Department of Medicine and Department of Rheumatic Diseases, University of Alberta, Edmonton; Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.S.L. Chow, MD; M.J. Bell, MD; Z. Bagheri, MD; D. Frackowiak, MD; B. Kuriya, MD, Division of Rheumatology, Department of Medicine, University of Toronto; J.C. Thorne, MD, Southlake Regional Health Centre; R. Ferrari, MD, Department of Medicine and Department of Rheumatic Diseases, University of Alberta; T. Boyd, MD; M. Jung, MD, Division of Rheumatology, Department of Medicine, Western University; A.M. Colwill, MD, Division of Rheumatology, Department of Medicine, University of British Columbia; G.S. Hazlewood, MD, Division of Rheumatology, Department of Medicine, University of Calgary; P. Tugwell, MD, Division of Rheumatology, Department of Medicine, University of Ottawa. Shirley.Chow@sunnybrook.ca.
• J Rheumatol. 2015 Apr 1; 42 (4): 682-9.

ObjectiveTo develop a list of 5 tests or treatments used in rheumatology that have evidence indicating that they may be unnecessary and thus should be reevaluated by rheumatology healthcare providers and patients.MethodsUsing the Delphi method, a committee of 16 rheumatologists from across Canada and an allied health professional generated a list of tests, procedures, or treatments in rheumatology that may be unnecessary, nonspecific, or insensitive. Items with high content agreement and perceived relevance advanced to a survey of Canadian Rheumatology Association (CRA) members. CRA members ranked these top items based on content agreement, effect, and item ranking. A methodology subcommittee discussed the items in light of their relevance to rheumatology, potential effect on patients, and the member survey results. Five candidate items selected were then subjected to a literature review. A group of patient collaborators with rheumatic diseases also reviewed these items.ResultsSixty-four unique items were proposed and after 3 Delphi rounds, this list was narrowed down to 13 items. In the member-wide survey, 172 rheumatologists responded (36% of those contacted). The respondent characteristics were similar to the membership at large in terms of sex and geographical distribution. Five topics (antinuclear antibodies testing, HLA-B27 testing, bone density testing, bone scans, and bisphosphonate use) with high ratings on agreement and effect were chosen for literature review.ConclusionThe list of 5 items has identified starting points to promote discussion about practices that should be questioned to assist rheumatology healthcare providers in delivering high-quality care.

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