Choosing Wisely Recommendations Using Administrative Claims Data

Crawford, Geoffrey B.; Clyman, Jeffrey I.; Chiou, David S.

doi:10.1001/jamainternmed.2016.0342

Cited by 2 publications

(4 citation statements)

References 5 publications

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“…Historically, it has been challenging to distinguish appropriate from inappropriate laboratory use because routinely collected clinical or administrative data lack detail about clinical reasoning. 12 13 32 Clinical practice guidelines typically recommend testing based on detailed clinical characteristics, which are challenging to discern from medical records, and are therefore rarely applicable for usage audits. 33 Both the mean abnormal result rate 20 22 and variation across physicians 2 4 11 20 21 have been used as indirect proxies for appropriateness.…”

Section: Discussionmentioning

confidence: 99%

“…However, identifying priorities to reduce low value testing remains a challenge. The Choosing Wisely campaign has primarily relied on expert opinion and, in some cases, this has led to recommendations in areas where there is no empiric evidence of overuse 10–16. Although baseline estimates of usage can provide information about which activities consume the most resources, they do not necessarily shed light on appropriate use.…”

Section: Introductionmentioning

confidence: 99%

“…The Choosing Wisely campaign has primarily relied on expert opinion and, in some cases, this has led to recommendations in areas where there is no empiric evidence of overuse. [10][11][12][13][14][15][16] Although baseline estimates of usage can provide information about which activities consume the most resources, they…”

Section: Introductionmentioning

confidence: 99%

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Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients

Weinerman¹,

Guo²,

Saha³

et al. 2023

BMJ Open Qual

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BackgroundReducing laboratory test overuse is important for high quality, patient-centred care. Identifying priorities to reduce low value testing remains a challenge.ObjectiveTo develop a simple, data-driven approach to identify potential sources of laboratory overuse by combining the total cost, proportion of abnormal results and physician-level variation in use of laboratory tests.Design, setting and participantsA multicentre, retrospective study at three academic hospitals in Toronto, Canada. All general internal medicine (GIM) hospitalisations between 1 April 2010 and 31 October 2017.ResultsThere were 106 813 GIM hospitalisations during the study period, with median hospital length-of-stay of 4.6 days (IQR: 2.33–9.19). There were 21 tests which had a cumulative cost >US$15 400 at all three sites. The costliest test was plasma electrolytes (US$4 907 775), the test with the lowest proportion of abnormal results was red cell folate (0.2%) and the test with the greatest physician-level variation in use was antiphospholipid antibodies (coefficient of variation 3.08). The five tests with the highest cumulative rank based on greatest cost, lowest proportion of abnormal results and highest physician-level variation were: (1) lactate, (2) antiphospholipid antibodies, (3) magnesium, (4) troponin and (5) partial thromboplastin time. In addition, this method identified unique tests that may be a potential source of laboratory overuse at each hospital.ConclusionsA simple multidimensional, data-driven approach combining cost, proportion of abnormal results and physician-level variation can inform interventions to reduce laboratory test overuse. Reducing low value laboratory testing is important to promote high value, patient-centred care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients

Weinerman¹,

Guo²,

Saha³

et al. 2023

BMJ Open Qual

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“…These algorithms codify the clinical circumstances under which the services constitute low-value care such that they can be discerned using claims data. In addition, at least two private organizations-Anthem [11] and Milliman [12]-have developed more comprehensive sets of such algorithms that can be used in conjunction with claims data to estimate the frequency of low-value use of the services included in their research. We have experimented with such algorithms using an all-payer claims data set for the state of New Hampshire and have concluded that such an approach is feasible.…”

Section: Additive Approachmentioning

confidence: 99%

A Framework for Measuring Low-Value Care

et al. 2018

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A comprehensive methodology for measuring and tracking low-value care in the United States would provide an important contribution toward reducing waste. Implementation of the framework described in this article appears feasible, and the proposed research program will allow moving incrementally toward full implementation while providing a near-term capability for measuring low-value care that can be enhanced over time.

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Choosing Wisely Recommendations Using Administrative Claims Data

Cited by 2 publications

References 5 publications

Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients

Data-driven approach to identifying potential laboratory overuse in general internal medicine (GIM) inpatients

A Framework for Measuring Low-Value Care

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