Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

Korenstein, Deborah; Chimonas, Susan; Barrow, Brooke; Keyhani, Salomeh; Troy, Aaron; Lipitz‐Snyderman, Allison

doi:10.1001/jamainternmed.2018.3573

Cited by 121 publications

(134 citation statements)

References 43 publications

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“…The ongoing use of low-value healthcare practices (i.e., low-value care), broadly defined as medical tests or treatments that lack efficacy, have risks that exceed benefit, or are not cost effective [1], impedes the delivery of safe, efficient, and cost-effective healthcare [2]. For patients and their caregivers, receiving a low-value test or treatment can lead to physical, psychological, and financial consequences [2][3][4]. Estimates suggest that unnecessary care in the USA costs upwards of $210 billion dollars annually [5] and consumes resources that could be allocated to high-value, necessary care.…”

Section: Introductionmentioning

confidence: 99%

Understanding the public’s role in reducing low-value care: a scoping review

Sypes¹,

Grood²,

Clement³

et al. 2020

Implementation Sci

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Background: Low-value care initiatives are rapidly growing; however, it is not clear how members of the public should be involved. The objective of this scoping review was to systematically examine the literature describing public involvement in initatives to reduce low-value care. Methods: Evidence sources included MEDLINE, EMBASE, and CINAHL databases from inception to November 26, 2019, grey literature (CADTH Tool), reference lists of included articles, and expert consultation. Citations were screened in duplicate and included if they referred to the public's perception and/or involvement in reducing lowvalue care. Public included patients or citizens without any advanced healthcare knowledge. Low-value care included medical tests or treatments that lack efficacy, have risks that exceed benefit, or are not cost-effective. Extracted data pertained to study characteristics, low-value practice, clinical setting, and level of public involvement (i.e., patient-clinician interaction, research, or policy-making). Results: The 218 included citations were predominantly original research (n = 138, 63%), published since 2010 (n = 192, 88%), originating from North America (n = 146, 67%). Most citations focused on patient engagement within the patient-clinician interaction (n = 156, 72%), using tools that included shared decision-making (n = 66, 42%) and patient-targeted educational materials (n = 72, 46%), and reported both reductions in low-value care and improved patient perceptions regarding low-value care. Fewer citations examined public involvement in low-value care policy-making (n = 33, 15%). Among citations that examined perspectives regarding public involvement in initiatives to reduce low-value care (n = 10, 5%), there was consistent support for the utility of tools applied within the patient-clinician interaction and less consistent support for involvement in policy-making. Conclusions: Efforts examining public involvement in low-value care concentrate within the patient-clinician interaction, wherein patient-oriented educational materials and shared decision-making tools have been commonly studied and are associated with reductions in low-value care. This contrasts with inclusion of the public in lowvalue care policy decisions wherein tools to promote engagement are less well-developed and involvement not consistently viewed as valuable.

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Section: Introductionmentioning

confidence: 99%

Understanding the public’s role in reducing low-value care: a scoping review

Sypes¹,

Grood²,

Clement³

et al. 2020

Implementation Sci

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show abstract

“…7,8 Unnecessary care is not only an economic waste; it could lead to significant harmful consequences for patients. 9 Nevertheless, most interventions have been targeted at reducing underuse rather than overuse. 10 In the hospital setting, however, indicators of variation in overuse are often lacking and rarely monitored in a sustained way by healthcare providers.…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…Unnecessary care is not only an economic waste; it could lead to significant harmful consequences for patients …”

Section: Introductionmentioning

confidence: 99%

Peer‐pressure and overuse: The effect of a multimodal approach on variation in benzodiazepine prescriptions in a network of public hospitals

et al. 2019

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Background The epidemic phenomenon leading to a progressive increase in benzodiazepine prescriptions represents a challenge for healthcare systems. In the hospital setting, indicators of prescription variation and potential of overuse are lacking and are rarely monitored. Inter‐hospital monitoring/benchmarking, via peer‐pressure, can foster the motivation to change. The aim of this investigation was to analyse whether, the reduction in new benzodiazepine prescriptions obtained thanks to a Choosing Wisely campaign, also contributed to reducing inter‐hospital variation. Methods Secondary analysis of a multicentre longitudinal intervention in a network of five teaching hospitals in Switzerland. We set out to explore the effect, on inter‐hospital benzodiazepine prescription variation, of a continuous monitoring/benchmarking strategy, which was proven effective in reducing the intra‐hospital prescription rate. The variance was used to assess inter‐hospital variation. To investigate the impact of the intervention a segmented regression analysis of interrupted time series was performed. Results A total of 36 299 admissions over 42 months were analysed (1 July 2014 to 31 December 2017). Before the intervention a significant constant upward trend in inter‐hospital variability was found (+0.901; SE 0.441; P < .05). After the intervention, the variance trend line significantly changed, decreasing by −0.257 (SE 0.005: P < .001) and producing by December 2017, a 27% absolute reduction. Conclusions Thanks to a multimodal approach based on monitoring‐benchmarking, a significant reduction in inter‐hospital benzodiazepine prescription variation was obtained. Aligning to peer strategy is a spontaneous consequence of open benchmarking that can be used to convert a variation‐based suspicion of overuse, into an occasion to actively review prescription habits.

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“…In fact, it is recommended to anticipate clinical management in a population characterized by reduced fecundity, thus in a population that would conversely need a longer rather than a shorter duration of pregnancy seeking to reach a reliable diagnosis of infertility (Somigliana et al, 2016). This situation can engender over-diagnosis and over-treatment and the well-known associated wastage of resources and undue exposure to risks (Carroll, 2017;Korenstein et al, 2018). Noteworthy, this tricky situation is complicated by the limited accuracy of the diagnostic work-up of infertility (Evers, 2012).…”

Section: Introductionmentioning

confidence: 99%

Is early initiation of infertility treatment justified in women over the age of 35 years?

Somigliana

Busnelli

Viganò

et al. 2020

Reproductive BioMedicine Online

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Research Question: Natural fecundity and IVF-ICSI success rate both decrease with age. For this reason, in women older than 35, it is generally recommended to initiate the infertility work-up earlier. However, this assumption may expose couples to over-diagnosis and over-treatment. Design: To shed light on this issue, we developed a theoretical model aimed at assessing the effects of starting the infertility work-up after 6 rather than 12 months of pregnancy seeking The assumptions of the model were: 1) infertile women are straightly treated with IVF-ICSI for up to three cycles; 2) IVF-ICSI success rate at first cycle linearly declines with age (3% per year), 3) the drop-out rate after the 1 st and 2 nd cycle is 18% and 25%, respectively, 4) the relative reduction of the success rate at 2 nd and 3 rd cycle is 16% and 26%, respectively. Results: On these bases, the anticipation moderately improved the cumulative chances of live birth of a full IVF-ICSI program. This improvement depended on age. Specifically, it increased from 2.0% at age 35 to 3.0% at age 43. Conversely, the incremental success rate per single IVF cycle was mainly stable, varying only from 1.4% at age 35 to 1.3% at age 43. Conclusions: In women older than 35, anticipation of the infertility work-up is associated with only a modest increase in the rate of success of IVF-ICSI. In most scenarios, this advantage may compare unfavorably with the chances of natural conception during the 6 months period.

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Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments

Abstract: formed the expert panel. Antonio DeRosa, MDS MLIS AHIP, Memorial Sloan Kettering Cancer Center, assisted with literature searches and Chris Kaeser, BFA, Memorial Sloan Kettering Cancer Center, provided design assistance. None of these individuals were compensated for their contribution.

Cited by 121 publications

References 43 publications

Understanding the public’s role in reducing low-value care: a scoping review

Understanding the public’s role in reducing low-value care: a scoping review

Peer‐pressure and overuse: The effect of a multimodal approach on variation in benzodiazepine prescriptions in a network of public hospitals

Is early initiation of infertility treatment justified in women over the age of 35 years?

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