Overuse in healthcare is a complex problem requiring a multifaceted, comprehensive approach that spans all levels of health systems. Choosing Wisely has made great strides by identifying areas of overuse through its lists and building comprehensive efforts to address overuse through bottom-up approaches. However, moving forward, the solutions to ending overuse must be implemented simultaneously at various levels and must balance the micro and macro aspects of the issue as those may be in conflict. Bottom-up approaches, as are already promoted by Choosing Wisely, can include educating the public and providers and promoting shared decision making. Top-down approaches at the organizational and system levels include changes in lab-order sets, re-evaluating services for disinvestment and using quality indicators appropriately. Choosing Wisely has done an excellent job of bringing attention to the issue, engaging providers and changing the overall culture to enable meaningful dialogue about addressing overuse. To enhance health outcomes and strengthen health systems, the way forward will need to include an interdisciplinary approach that meaningfully engages patients and focuses on rapid cycles of identifying and diagnosing areas of overuse and implementing and evaluating approaches to address them.
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