{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T18:51:35Z","timestamp":1792349495216,"version":"4.4.0"},"reference-count":74,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T00:00:00Z","timestamp":1792281600000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Low\u2010value care represents a major and under\u2010recognized threat to quality, safety, and sustainability in clinical endocrinology. This review aims to critically examine the role of overdiagnosis and overtreatment as key drivers of low\u2010value care and to identify strategies to support the transition towards value\u2010based endocrine practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a narrative review integrating current evidence on low\u2010value care, overdiagnosis, and overtreatment in endocrinology. We also analyzed major international initiatives (e.g., Choosing Wisely, Right Care) and national programs, with particular focus on the \u201cdo not do\u201d recommendations developed by the Spanish Society of Endocrinology and Nutrition (SEEN), as well as emerging frameworks from implementation and deimplementation science.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Low\u2010value practices are highly prevalent in endocrinology, driven by extensive use of diagnostic testing, evolving disease definitions, and uncertainty in clinical decision\u2010making. These factors contribute to overdiagnosis and overtreatment, often triggering diagnostic\u2013therapeutic cascades that increase patient harm, psychological burden, and healthcare costs without improving clinically meaningful outcomes. Although \u201cdo not do\u201d recommendations and guideline\u2010based initiatives provide actionable tools, their impact remains limited due to clinical inertia, cultural norms favoring intervention, and systemic barriers to deimplementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reducing low\u2010value care is essential to advancing high\u2010quality, patient\u2010centered endocrinology. This requires not only evidence\u2010based recommendations but also transformative changes in clinical culture, clinician behavior, and healthcare systems, ensuring that care consistently maximizes benefit while minimizing harm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70687","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T18:34:36Z","timestamp":1792348476000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving Adequacy in Endocrine Practice: Reducing Low\u2010Value Care and Advancing Value\u2010Based Medicine"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2017-0694","authenticated-orcid":false,"given":"Juan J.","family":"D\u00edez","sequence":"first","affiliation":[{"name":"Department of Endocrinology Hospital Universitario Puerta de Hierro Majadahonda Majadahonda Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Puerta de Hierro Segovia de Arana Majadahonda Spain"},{"name":"Department of Medicine Universidad Aut\u00f3noma de Madrid Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1011024"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-154-3-201102010-00007"},{"key":"e_1_2_12_4_1","volume-title":"Improving Diagnosis in Health Care","author":"National Academy of Medicine","year":"2015"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001143"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-021-06639-2"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-021-02732-y"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/virtualmentor.2014.16.2.pfor2-1402"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32585-5"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.p1865"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2025-113804"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2017-007571"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k2820"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.5086"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17111764"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/joim.13465"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.29891"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e3502"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmed-2017-110886"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.1739"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2019.0054"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-079970"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.34172\/ijhpm.2022.6833"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz400"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/ejendo\/lvad066"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-025-01168-y"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1604412"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aprim.2018.08.004"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.13770"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2025.120479"},{"key":"e_1_2_12_31_1","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee. 9. 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