The state of overuse measurement: A critical review

Medical Care Research and Review

Volumn 70, Issue 5, 2013, Pages 473-496

  Chan, Kitty S ^a   Chang, Eva ^a   Nassery, Najlla ^b   Chang, Hsien Yen ^a   Segal, Jodi B ^a,b  

^a JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH   (United States)

^b JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

health care costs; health care overuse; inappropriate care; performance measurement; quality measurement

Indexed keywords

ALPHA2A INTERFERON; ANTIBIOTIC AGENT; ANTIHISTAMINIC AGENT; ANTILIPEMIC AGENT; ANTINUCLEAR ANTIBODY; BARIUM; BRAIN NATRIURETIC PEPTIDE; CORTICOSTEROID; CREATININE; D DIMER; DECONGESTIVE AGENT; DIETHYLSTILBESTROL; FENFLURAMINE; HEMOGLOBIN; HEPARIN; HISTAMINE H2 RECEPTOR ANTAGONIST; HYDRALAZINE; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; IRON; LIDOCAINE; NONSTEROID ANTIINFLAMMATORY AGENT; PHENTERMINE; QUINIDINE; ROSIGLITAZONE; SEROTONIN UPTAKE INHIBITOR; STEROID; THALIDOMIDE; TRIPARANOL;

ALLERGY; ANTIBIOTIC THERAPY; BACKACHE; BREAST CANCER; CANCER SCREENING; CEREBROVASCULAR ACCIDENT; CERVICAL SPINE INJURY; COLON CANCER; COMPUTER ASSISTED TOMOGRAPHY; CONGESTIVE HEART FAILURE; CORONARY ARTERY DISEASE; DIABETES MELLITUS; DIAGNOSTIC TEST; DRUG UTILIZATION; EXTERNAL OTITIS; GASTROESOPHAGEAL REFLUX; GASTROINTESTINAL ENDOSCOPY; HEADACHE; HEALTH CARE OVERUSE; HEALTH CARE UTILIZATION; HEART ARRHYTHMIA; HEART ATRIUM FIBRILLATION; HUMAN; IRON THERAPY; LOW RISK POPULATION; LUNG EMBOLISM; MAMMOGRAPHY; MELANOMA; MIGRAINE; NEOPLASM; OBESITY; OTITIS MEDIA; PATIENT MONITORING; PHARYNGITIS; PROSTATE CANCER; RETINA MACULA AGE RELATED DEGENERATION; REVIEW; SCREENING TEST; SKIN ULCER; SPONTANEOUS ABORTION; STEROID THERAPY; SUDDEN DEATH; SYSTEMATIC REVIEW; TENSION HEADACHE; TRAUMATIC BRAIN INJURY; TREATMENT INDICATION; UPPER RESPIRATORY TRACT INFECTION; URINE INCONTINENCE; URTICARIA; WOUND CARE;

HEALTH CARE COSTS; HEALTH CARE OVERUSE; INAPPROPRIATE CARE; PERFORMANCE MEASUREMENT; QUALITY MEASUREMENT;

HEALTH SERVICES MISUSE; HUMANS; QUALITY INDICATORS, HEALTH CARE; REFERRAL AND CONSULTATION;

EID: 84885099507     PISSN: 10775587     EISSN: 15526801     Source Type: Journal    
DOI: 10.1177/1077558713492202     Document Type: Review

References (51)

1. Ackerman S., Gonzales R.. The context of antibiotic overuse. Annals of Internal Medicine. 2012 ; 157: 211-212
2. Agency for Healthcare Research and Quality. (2002, September). Improving health care quality: Fact sheet (AHQR Publication No. 02-P032). Rockville, MD: Author. Retrieved from http://www.ahrq.gov/news/qualfact.pdf
3. Health care efficiency measures: Identification, categorization, and evaluation. Rockville, MD: Author ; 2008 :
4. ABIM Foundation. (n.d.). Choosing wisely: Five things physicians and patients should question: Lists. Retrieved from http://www.choosingwisely.org/ doctor-patient-lists
5. American College of Cardiology. (2011, January20). Guidelines & quality standards. Retrieved from http://www.cardiosource.org/Science-And- Quality/Practice-Guidelines-and-Quality-Standards.aspx
6. Blue Cross Blue Shield of Massachusetts. (2009, March). The alternative quality contract. Retrieved from http://www.qualityaffordability.com/pdf/ alternative-quality-contract.pdf
7. Brenner D. J., Hall E. L.. Computed tomography: An increasing source of radiation exposure. New England Journal of Medicine. 2007 ; 357: 2277-2284
8. Centers for Medicare and Medicaid Services. (2010). 2010 PQRI measures list. Retrieved from http://www.cms.gov/PQRI/Downloads/2010-PQRI-MeasuresList- 111309.pdf
9. Chassin M. R., Galvin R. W.. The urgent need to improve health care quality: Institute of Medicine National Roundtable on Health Care Quality. Journal of the American Medical Association. 1998 ; 280: 1000-1005
10. Douglas P. S., Garcia M. J., Haines D. E., Lai W. W., Manning W. J., Patel A. R., Weiner R. B.. ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. Journal of the American Society of Echocardiography. 2011 ; 24: 229-267
11. Epstein A. M.. Geographic variation in Medicare spending. New England Journal of Medicine. 2010 ; 363: 85-86
12. Fazel R., Krumholz H. M., Wang Y., Ross J. S., Chen J., Ting H. H., Nallamothu B. K.. Exposure to low-dose ionizing radiation from medical imaging procedures. New England Journal of Medicine. 2009 ; 361: 849-857
13. Fisher E. S., Wennberg D. E.. Health care quality, geographic variations and the challenge of supply-sensitive care. Perspectives in Biology and Medicine. 2003 ; 46: 69-79
14. Fisher E. S., Wennberg D. E., Stukel T. A., Gottlieb D. J., Lucas F. L., Pinder E. L.. The implications of regional variations in Medicare spending. Part 1: The content, quality, and accessibility of care. Annals of Internal Medicine. 2003 ; 138: 273-287
15. Fuchs V. R.. Eliminating "waste" in health care. Journal of the American Medical Association. 2009 ; 302: 2481-2482
16. Garner S., Littlejohns P.. Disinvestment from low value clinical interventions: NICEly done?. British Medical Journal. 2011 ; 343: d4519
17. Medicare: Millions can be saved by screening claims for overused services. Washington, DC: Author ; 1996 :
18. The "Top 5" Lists in primary care: Meeting the responsibility of professionalism. Archives of Internal Medicine. 2011 ; 171: 1385-1390
19. Gonzales R., Anderer T., McCulloch C. E., Maselli J. H., Bloom F. J, Graf T. R., Metlay J. P.. A cluster randomized trial of decision support strategies for reducing antibiotic use in acute bronchitis. JAMA Internal Medicine. 2013 ; 173: 267-273
20. Government Accountability Office. (2008, June). Report to Congressional requesters: Medicare Part B imaging services: Rapid spending growth and shift to physician offices indicate need for CMS to consider additional management practices (GAO-08-452). Washington, DC: Author. Retrieved from http://www.gao.gov/new.items/d08452.pdf
21. Hendel R. C., Berman D. S., Di Carli M. F., Heidenreich P. A., Henkin R. E., Pellikka P. A., Williams K. A.. ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging. Circulation. 2009 ; 119: e561 - e587
22. Iglehart J. K.. Health insurers and medical-imaging policy - A work in progress. New England Journal of Medicine. 2009 ; 360: 1030-1037
23. Knowing what works in health care: A roadmap for the nation. Washington, DC: National Academies Press ; 2008 :
24. Kahan J. P., Bernstein S. J., Leape L. L., Hilborne L. H., Park R. E., Parker L., Brook R. H.. Measuring the necessity of medical procedures. Medical Care. 1994 ; 32: 357-365
25. Kern L. M., Dhopeshwarkar R., Barrón Y., Wilcox A., Pincus H., Kaushal R.. Measuring the effects of health information technology on quality of care: A novel set of proposed metrics for electronic quality reporting. Joint Commission Journal on Quality and Patient Safety. 2009 ; 35: 359-369
26. Keyhani S., Siu A. L.. The underuse of overuse research. Health Services Research. 2008 ; 43: 1923-1930
27. Korenstein D., Falk R., Howell E. A., Bishop T., Keyhani S.. Overuse of health care services in the United States: An understudied problem. Archives of Internal Medicine. 2012 ; 172: 171-178
28. Légaré F., Labrecque M., Cauchon M., Castel J., Turcotte S., Grimshaw J.. Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: A cluster randomized trial. Canadian Medical Association Journal. 2012 ; 184: E726 - E734
29. McGlynn E. A. Identifying, Categorizing, and Evaluating Health Care Efficiency Measures. Rockville, MD: Agency for Healthcare Research and Quality ; 2008 :
30. Moja L., Cusi C., Sterzi R., Canepari C.. Selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headaches. Cochrane Database of Systematic Reviews. 2005 ; 3: CD002919
31. National Committee for Quality Assurance. (2005). NCQA releases HEDIS® 2006; New measures address overuse, follow-up. Washington DC: Author. Retrieved from http://www.ncqa.org/tabid/277/Default.aspx
32. Developing a framework and research agenda for overuse and appropriateness measures. Washington DC: Author ; 2009 :
33. National Committee for Quality Assurance. (2010). The state of health care quality: Reform, the quality agenda and resource use, 2010. Washington DC: Author. Retrieved from http://www.ncqa.org/portals/0/state%20of%20health%20care/ 2010/sohc%202010%20-%20full2.pdf
34. National Institute for Health and Clinical Excellence. (n.d.). Search the NICE "do not do" recommendations database. Retrieved from http://www.nice.org.uk/usingguidance/donotdorecommendations/search.jsp
35. Identification of potential 2013 e-Quality measures. Washington, DC: Author ; n.d. :
36. National Quality Measures Clearinghouse. (n.d.). Measure summary: Use of imaging studies for low back pain: Percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain x-ray, MRI, CT scan) within 28 days of the diagnosis. Retrieved from http://www.guideline. gov/content.aspx?id=34670
37. National priorities and goals: Aligning our efforts to transform America's healthcare. Washington, DC: National Quality Forum ; 2008 :
38. Orzag P. R. The overuse, underuse and misuse of health care. Washington, DC: Congressional Budget Office ; 2008 :
39. QualityNet. (n.d.). Imaging efficiency measures. Retrieved from http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename= QnetPublic%2FPage%2FQnetTier2&cid=1228695266120
40. Qaseem A., Alguire P., Dallas P., Feinberg L. E., Fitzgerald F. T., Horwitch C., Weinberger S.. Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Annals of Internal Medicine. 2012 ; 156: 147-149
41. Sakala C., Corry M. P. Evidence-based maternity care: What it is and what it can achieve. New York, NY: Milbank Memorial Fund ; 2008 :
42. ScholleS. H. (2010). Advancing quality in women's health [PowerPoint slides]. Retrieved from http://www.academyhealth.org/files/2010/saturday/ scholle.pdf
43. Sirovich B. E., Gottlieb D. J., Welch H. G., Fisher E. S.. Regional variations in health care intensity and physician perceptions of quality of care. Annals of Internal Medicine. 2006 ; 144: 641-649
44. Siontis G. C. M., Tzoulaki I., Siontis K., Ioannidis J. P. A.. Comparisons of established risk prediction models for cardiovascular disease: Systematic review. British Medical Journal. 2012 ; 344: e3318
45. Sistrom C. L., Dang P. A., Weilburg J. B, Dreyer K. J., Rosenthal D. I., Thrall J. H.. Effect of computerized order entry with integrated decision support on the growth of outpatient procedure volumes: Seven-year time series analysis. Radiology. 2009 ; 251: 147-155
46. Smith-Bindman R., Miglioretti D. L., Johnson E., Lee C., Feigelson H. S., Flynn M., Williams A. E.. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems 1996-2010. Journal of the American Medical Association. 2012 ; 307: 2400-2409
47. Song Y., Skinner J., Bynum J., Sutherland J., Wennberg J. E., Fisher E. S.. Regional variations in diagnostic practices. New England Journal of Medicine. 2010 ; 363: 45-53
48. Taylor A. J., Cerqueira M., Hodgson J. M., Mark D., Min J., O'Gara P., Smith S. C.. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. Journal of the American College of Cardiology. 2010 ; 56: 1864-1894
49. U.S. Preventive Services Task Force. (n.d.). Recommendations. Retrieved from http://www.uspreventiveservicestaskforce.org/recommendations.htm
50. Vartanians V. M., Sistrom C. L., Weilburg J. B., Rosenthal D. I., Thrall J. H.. Increasing the appropriateness of outpatient imaging: Effects of a barrier to ordering low-yield examinations. Radiology. 2010 ; 255: 842-849
51. Zuckerman S., Waidman T., Berenson R., Hadly J.. Clarifying sources of geographic differences in Medicare spending. New England Journal of Medicine. 2010 ; 363: 54-62