Choosing Wisely: Prevalence and Correlates of Low-Value Health Care Services in the United States

Frequency of and variation in low-value care in primary care: a retrospective cohort study

“…Furthermore, our study includes an entire population from a single payer, publicly funded system with no patient copayments, which is novel because most previous research on overuse has been done in the US. 16,17,19 The lower rates of cervical screening and imaging for low back pain compared with repeat DEXA scans may reflect increased penetrance of guideline recommendations and policy changes. The Ontario government amended the fee schedule to align with the guideline changes made in 2012: 20 effective January 2013, cervical cancer screening was not insured for women less than 21 or more than 70 years of age.…”

“…31, 2013. Drawing from indicator definitions in the literature, [13][14][15][16][17] we developed algorithms using physician claims and hospital encounter data to identify the cohorts for each study recommendation. In brief, we selected patients meeting eligibility criteria for 1 or more cohort: adults with a diagnosis of low back pain without red flags from a family physician based on methods developed by ICES; 13 women aged 13-21 years or 69-105 years with no prior diagnoses of gynecological cancer or hysterectomy based on a validated algorithm to identify women who underwent screening for cervical cancer in Ontario; 15 or adults 40 years of age and older who received a DEXA scan based on billing claims previously described by Jaglal and colleagues and previously validated.…”

Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations

“…Because we expected there would be changes in screening patterns, we also conducted exploratory regression analyses to examine the association between regional change patterns and regional characteristics that are known to be related to health and healthcare systems. 27 …”

Evaluating the Evidence for Choosing WiselyTM in Primary Care Using the Strength of Recommendation Taxonomy (SORT)

“…The prevalence of nonbeneficial services in primary care settings remains high; for example, 46.5% of fee-for-service Medicare beneficiaries who underwent low-risk, noncardiac procedures from 2006 to 2011 received preoperative cardiac testing. 5 Implementing Choosing Wisely in primary care could yield substantial benefits for patients and reduce medical costs. However, it may be difficult to convince primary care clinicians to change established practices if, as some have asserted, 6 supporting evidence for assessments of services considered "low value" is limited.…”