Impact of implementing a Choosing Wisely educational intervention into clinical practice: The CW-SIMI study (a multicenter-controlled study)

Giorgio Costantino, Ludovico Furlan, Christian Bracco, Maria Domenica Cappellini, Giovanni Casazza, Vanessa Nunziata, Chiara Beatrice Cogliati, Anna Fracanzani, Raffaello Furlan, Giovanni Gambassi, Roberto Manetti, Raffaele Manna, Alfonso Piccoli, Alberto Moggi Pignone, Gian Marco Podda, Teresa Salvatore, Stefania Sella, Alessandro Squizzato, Moreno Tresoldi, Francesco PerticoneAntonello Pietrangelo, Gino Roberto Corazza, Nicola Montano

Research output: Contribution to journalArticlepeer-review


Objectives: To evaluate the impact of an educational intervention based on the Italian Society of Internal Medicine Choosing Wisely (CW-SIMI) recommendations. Design: Multicenter, interventional, controlled study. Setting: Twenty-three acute-care hospital wards in Italy. Participants: 303 Physicians working in internal medicine wards. Intervention: An online educational course. Main outcomes: The rate of proton pump inhibitor (PPI) prescriptions, the number of days of central venous catheter (CVC) usage, and the duration of intravenous (IV) antibiotic prescriptions evaluated at one month (T1) and at six months (T2) after course completion. Patients admitted and discharged during a 30-day period before the educational intervention (T0, one year before T2) were considered the comparison group. Results: A total of 232 physicians completed the course, while 71 did not attend the course. Data from 608, 662, and 555 patients were analyzed at T0, T1, and T2, respectively. The rate of PPI prescriptions declined at one month (RR: 0.67, 95% CI: 0.52–0.87, p = 0.0005) and at six months (RR: 0.62, 95% CI: 0.46–0.84, p = 0.003), and the number of days of CVC usage was reduced at six months (9.13 days at T0 vs. 5.52 days at T2, p = 0.007). The duration of IV antibiotic prescriptions displayed a decreasing trend (7.94 days at T0 vs. 7.42 days at T2, p = 0.081). Conclusions: A simple online educational intervention based on the CW-SIMI recommendations was associated with a clinically relevant reduction in the usage of PPIs and CVCs. Further studies are needed to confirm these findings and a possible benefit on patients’ outcomes.

Original languageEnglish
Pages (from-to)71-77
JournalEuropean Journal of Internal Medicine
Publication statusPublished - 2021


  • Antibiotics
  • Appropriateness
  • Choosing wisely
  • Cvc
  • Less is more
  • Proton pump inhibitors

ASJC Scopus subject areas

  • Internal Medicine


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