Healthcare Overuse: A Literature Review and Taxonomy Proposal

Abstract

Healthcare overuse is the provision of care in which the benefits do not justify the harms and/or costs. Overuse literature is poorly categorized thus impeding research, practice, and policy to reduce overuse and improve healthcare quality. We developed an overuse taxonomy and searched for and reviewed the healthcare overuse literature in an attempt to better understand and categorize research on overuse practice and patterns. We found that more than two-thirds of articles were observational (70%), the most prevalent purpose of overuse was treatment/secondary prevention (69%), the most common type of overuse was overtreatment (73%), drivers of and methods to reduce overuse were each discussed in about 40% of abstracts, and the most frequently mentioned clinical area was pharmacy. A high volume of overuse literature exists. However, the majority of overuse research is observational, descriptive, and focuses on overtreatment and overprescribing rather than methods to reduce overuse. Some overuse is not labelled as such. Our taxonomy adequately organized the existing literature and identified areas where additional research efforts are most needed. A common taxonomy, such as ours, could help researchers categorize their work, assist clinicians and policymakers in identifying and implementing findings, and guide future research to improve healthcare quality.