Curbing Unnecessary and Wasted Diagnostic Imaging

Oren, Ohad; Kebebew, Electron; Ioannidis, John P. A.

doi:10.1001/jama.2018.20295

Cited by 72 publications

(55 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…How patients and the public are optimally involved in initiatives to reduce low-value care has been highlighted as a deficiency in the science that underpins reducing low-value care [15,20]. While a number of reviews and editorials speak to engaging the public in reducing low-value care [1,[21][22][23], there is a poor understanding of which organizations and stakeholders should engage the public, the extent to which the public should be involved, and how public involvement impacts initiatives to reduce low-value care, and importantly, how members of the public themselves wish to be involved.…”

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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…It may not be one that we consciously choose, but it is one that has consequences for both the individual and the collective (Rosenbaum, ). With regard to health care, focusing exclusively on just one part of the system (physician behavior) or on one isolated goal (reducing hospital readmissions)—without taking into account the other stakeholders (patients) and interactive context involved—has resulted in unfairly villainizing physicians as greedy for financial gain when the greed is “more often a hunger for information” (Rosenbaum, ), increased (avoidable) mortality (Fonarow, ), and a failure to recognize that “effective interventions may need to occur concurrently at multiple points in the system and involve both clinicians and patients” (Oren, Kebebew, & Ioannidis, ). This “inattentional blindness,” however, does not have to be permanent.…”

Section: Resultsmentioning

confidence: 99%

The Physics of Health Care: Viewing the U.S. Health‐Care “System” from the Perspective of Quantum Mechanics

Kislyakov¹,

Mayes²

2019

World Med & Health Policy

View full text Add to dashboard Cite

Leading explanations for high per capita and total health‐care spending in the United States tend to point to high health‐care prices as the primary culprit, which are a major contributor. Yet prices and spending do not exist in siloed vacuums. They are inherently part of, and deeply intertwined with, patient and clinician interactions, administrative norms and requirements, organizational structures, and socio‐cultural systems of medicine. Consequently, what is often thought of as a bounded health‐care “system”—centered primarily around the volume and price of health care—may, in fact, be unbounded, spilling over and interacting with other seemingly unrelated domains. Adding to the scholarly work already addressing this issue, we aim to provide a new lens that captures (if only partially) the exquisitely complex and hidden equilibrium present in what constitutes U.S. health care. Quantum and relativistic physics, with its focus on non‐deterministic reasoning, can serve as a helpful framework for understanding the moving parts of health care—their interposition as well as their interdependence. Using this analytic lens could potentially lead to new interventions (involving clinicians, patients, and payers) that concurrently target problems at multiple points in the system.

show abstract

“…6,8 This finding is consistent with a pattern of imaging overuse in the US, which has amongst the highest utilization rates globally for advanced imaging such as CT and MRI. 10,11 Identifying opportunities to safely reduce routine imaging, particularly CT imaging, in this population could decrease unnecessary radiation exposure without compromising outcomes.…”

Section: Discussionmentioning

confidence: 99%

Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Desai

Shah

Hall

et al. 2019

Journal of Hospital Medicine

View full text Add to dashboard Cite

OBJECTIVES: This study aimed to describe variation in imaging practices and examine the association between early imaging and outcomes in children hospitalized with cervical lymphadenitis. METHODS: This multicenter cross-sectional study included children between two months and 18 years hospitalized with cervical lymphadenitis between 2013 and 2017. Children with complex chronic conditions, transferred from another institution, and with prior hospitalizations for lymphadenitis were excluded. To examine hospital-level variation, we calculated the proportion of children at each hospital who received any imaging study, early imaging (conducted on day 0 of hospitalization), multiple imaging studies, and CT imaging. Generalized linear or logistic mixed effects models examined the association between early imaging and outcomes (ie, multiple imaging studies, surgical drainage, 30-day readmission, and length of stay) while accounting for patient demographics, markers of illness duration and severity, and clustering by hospital. RESULTS: Among 10,014 children with cervical lymphadenitis, 61% received early imaging. There was hospital-level variation in imaging practices. Compared with children who did not receive early imaging, children who received early imaging presented increased odds of having multiple imaging studies (adjusted odds ratio [aOR] 3.0; 95% CI: 2.6-3.6), surgical drainage (aOR 1.3, 95%CI: 1.1-1.4), and 30-day readmission for lymphadenitis (aOR 1.5, 95%CI: 1.2-1.9), as well as longer lengths of stay (adjusted rate ratio 1.2, 95%CI: 1.1-1.2). CONCLUSIONS: Children receiving early imaging had more resource utilization and intervention than those without early imaging. Our findings may represent a cascade effect, in which routinely conducted early imaging prompts clinicians to pursue additional testing and interventions in this population.

show abstract

Curbing Unnecessary and Wasted Diagnostic Imaging

Cited by 72 publications

References 11 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

The Physics of Health Care: Viewing the U.S. Health‐Care “System” from the Perspective of Quantum Mechanics

Imaging Strategies and Outcomes in Children Hospitalized with Cervical Lymphadenitis

Contact Info

Product

Resources

About