Choosing wisely: Elección inteligente

Authors

  • Silvana Salerno Medica pediatra, legista y auditora. Jefa del Departamento Técnico HNRG. Miembro del Comité de Calidad y Seguridad, HNRG

Keywords:

Prácticas de bajo valor, Criterio médico, Toma de decisiones

Abstract

Sección a cargo del Comité de Calidad y Seguridad del Paciente HNRG

La medicina actual, en un contexto de preocupación por el exceso en el actuar médico, y sus consecuencias ha puesto su mirada en la necesidad de optimizar la toma de decisiones, evaluando los riesgos y beneficios de las intervenciones diagnósticas y terapéuticas. En esta línea surgió en Estados Unidos la iniciativa “Choosing wisely”. Esta es una iniciativa global que aborda la problemática de las prácticas de bajo valor (PBV), que son aquellas intervenciones terapéuticas o diagnósticas carentes de respaldo científico, que aumentan la probabilidad de daño, generan desperdicio de recursos y amenazan la eficiencia del sistema de salud.

En este artículo se presentan los objetivos y principales características de esta iniciativa. 

References

American Board of Internal Medicine Foundation, Choosing Wisely, Consumer Reports. Choosing Wisely: a special report of the first five years. Octubre 26, 2017. [Internet] [Consultado 15-2-2026]. Disponible en https://www.choosingwisely.org/files/Choosing-Wisely-at-Five.pdf

Kopitowski K. Lanzamiento de la campaña Choosing Wisely Argentina: primeros pasos hacia la desimplementación de prácticas de bajo valor. Evidencia Actualización En La práctica Ambulatoria 2024; 27(1): e007110. [Internet] Consultado 7-2-2026. Disponible en https://doi.org/10.51987/evidencia.v27i1.7110.

Wonca International Classification Committee. Wonca International Dictionary of General/Family Practice. Bentzen N, editor. Copenhagen; 2003. [Internet] Consultado 7-2-2026. Disponible en http://www.ph3c.org/ph3c/docs/27/000092/0000052.pdf

Association of family health Teams of Ontario. Implementing Choosing Wisely Canada Recommendations in Ontario to Improve Quality of Care: HQO Report. 2017. [Internet] [Consultado 7-2-2026]. Disponible en: https://www.afhto.ca/news-events/news/implementing-choosing-wisely-canada-recommendations-ontario-improve-quality-care

Kerr EA, Kullgren JT, Saini SD. Choosing Wisely: How To Fulfill The Promise In The Next 5 Years. Health Aff (Millwood). 2017; 36(11):2012-2018. doi: 10.1377/hlthaff.2017.0953. Disponible en https://pubmed.ncbi.nlm.nih.gov/29137505/

Ministerio de Salud de la República Argentina. Recomendaciones de no hacer. 2021. [Internet] Consultado 23-1-2026 Disponible en https://www.argentina.gob.ar/sites/default/files/no-hacer-flyer-2021.pdf

Comité de Seguridad de Calidad y Seguridad del paciente. Seguridad del paciente. Rev Hosp. Niños (B. Aires) 2019; 61 (273):108.

Howick D, Koletsi D, Ioannidis JPA, et al. Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: A systematic review and meta-analysis. J Clin Epidemiol. 2022; 148:160–169 Disponible en: https://pubmed.ncbi.nlm.nih.gov/35447356/

Casarett D. The Science of Choosing Wisely–Overcoming the Therapeutic Illusion. N Engl J Med. 2016; 374 (13):1203–1205.

Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC); Cloutier MM, Baptist AP, Blake KV, et al. 2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020; 146(6):1217-1270. doi: 10.1016/j.jaci.2020.10.003. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33280709/

Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014; 134(5):e1474-e1502. PMID: 25349312.

Trottier ED, Chan K, Allain D, et al. Managing the paediatric patient with an acute asthma exacerbation. Paediatr Child Health. 2021; 26(7):438-439. PMID: 34777663.

Schuh S, Lalani A, Allen U, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007; 150(4):429-433. PMID: 17382126.

Shah SN, Bachur RG, Simel DL, et al. Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review. JAMA. 2017; 318(5):462-471. PMID: 28763554.

Chun TH. Medical clearance: time for this dinosaur to go extinct. Ann Emerg Med. 2014; 63(6):676-677. PMID: 24342816.

Donofrio JJ, Santillanes G, McCammack BD, et al. Clinical utility of screening laboratory tests in pediatric psychiatric patients presenting to the emergency department for medical clearance. Ann Emerg Med. 2014; 63(6):666-675.e1. PMID: 24219903.

Donofrio JJ, Horeczko T, Kaji A, et al. Most routine laboratory testing of pediatric psychiatric patients in the emergency department is not medically necessary. Health Aff (Millwood). 2015; 34(5):812-8. doi: 10.1377/hlthaff.2014.1309.

Thrasher TW, Rolli M, Redwood RS, et al. 'Medical Clearance' of Patients With Acute Mental Health Needs in the Emergency Department: A Literature Review and Practice Recommendations. WMJ. 2019; 118(4):156-163. PMID: 31978283.

Santillanes G, Donofrio JJ, Lam CN, et al. Is medical clearance necessary for pediatric psychiatric patients? J Emerg Med. 2014; 46(6):800-807. doi: 10.1016/j.jemermed.2013.12.003.

Santiago LI, Tunik MG, Foltin GL, et al. Children requiring psychiatric consultation in the pediatric emergency department: epidemiology, resource utilization, and complications. Pediatr Emerg Care. 2006; 22(2):85-89. doi: 10.1097/01.pec.0000199568.94758.6e.

Berg JS, Payne AS, Wavra T, et al. Implementation of a Medical Clearance Algorithm for Psychiatric Emergency Patients. Hosp Pediatr. 2023; 13 (1): 66-71. doi.org/10.1542/hpeds.2022-006672.

Berger MY, Tabbers MM, Kuradijat AD, et al. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J Pediatr. 2012; 161(1):44-50.e2. PMID: 22341242.

Freedman SB, Rodean J, Hall M, et al. Delayed Diagnoses in Children with Constipation: Multicenter Retrospective Cohort Study. J Pediatr. 2017; 186:87-94.e16. doi: 10.1016/j.jpeds.2017.03.061.

Freedman SB, Thull-Freedman J, Manson D, et al. Pediatric abdominal radiograph use, constipation, and significant misdiagnoses. J Pediatr. 2014; 164(1):83-88.e2. doi: 10.1016/j.jpeds.2013.08.074.

Kearney R, Edwards T, Bradford M, Klein E. Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation. Pediatr Emerg Care. 2019; 35(9):624-629. doi: 10.1097/PEC.0000000000001549

Pensabene L, Buonomo C, Fishman L, et al. Lack of utility of abdominal radiographs in the evaluation of children with constipation: comparison of different scoring methods. J Pediatr Gastroenterol Nutr. 2010; 51(2):155-159. doi: 10.1097/MPG.0b013e3181cb4309.

Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014; 58(2):258-274. PMID: 24345831.

American Academy of Pediatrics. COVID-19 [Internet]. Itasca (IL): AAP; c2026 [actualizado 11 Dic 2025; citado 1 Abr 2026]. Disponible en: https://www.aap.org/en/patient-care/covid-19/

Gill PJ, Richardson SE, Ostrow O, et al. Testing for Respiratory Viruses in Children: To Swab or Not to Swab? JAMA Pediatrics. 2017; 171(8):798-804. doi: 10.1001/jamapediatrics.2017.0786.

Innis K, Hasson D, Bodilly L, et al. Do I Need Proof of the Culprit? Decreasing Respiratory Viral Testing in Critically Ill Patients. Hosp Pediatr. 2021; 11(1):e1-e5. doi: 10.1542/hpeds.2020-000943. Epub 15 Dic. 2020. PMID: 3332339

Noël KC, Fontela PS, Winters N, et al. The Clinical Utility of Respiratory Viral Testing in Hospitalized Children: A Meta-analysis. Hosp Pediatr. 2019; 9(7):483-494. doi: 10.1542/hpeds.2018-0233

Parikh K, Hall M, Mittal V, et al. Establishing benchmarks for the hospitalized care of children with asthma, bronchiolitis, and pneumonia. Pediatrics. 2014; 134(3):555-62. doi: 10.1542/peds.2014-1052. PMID: 25136044

Cliff BQ, Avanceña ALV, Hirth RA, et al. The Impact of Choosing Wisely Interventions on Low-Value Medical Services: A Systematic Review. Milbank Q. 2021; 99(4):1024-1058. doi: 10.1111/1468-0009.12531.

Published

2026-04-27