Identifying Possible Indicators of Systematic Overuse of Health Care Procedures With Claims Data

Abstract

We identified a set of overused procedures that may be used as measures of overuse and that demonstrate significant variance in their usage. The implication is that an index of overuse might be built from these indicators that would reveal systematic patterns of overuse within regions. Alternatively, these indicators may be valuable in the quality improvement efforts.

Evidence for overuse of medical services around the world

“…First, we are only beginning to conceptualize overuse as a general system problem and to develop system-level metrics. 186 There are no measures in general use. Second, health care systems are complex and dynamic; 187 reducing or eliminating overuse of one service or in one site of care can encourage overuse in another.…”

The Association Between Continuity of Care and the Overuse of Medical Procedures

“…24 We operationalized overuse using items from a previously studied set of 19 potentially overused procedures, including 13 diagnostic, 3 therapeutic, 2 screening, and 1 monitoring procedures. 25 These measures were derived from publications of national professional societies and consumer groups with interests in quality improvement or cost-containment and were selected if they were obtainable from claims data and relevant for patients older than 65 years. 26 These measures have been previously linked with considerable variability between and within hospital referral regions.…”

An Index for Measuring Overuse of Health Care Resources With Medicare Claims

“…The methods of operationalizing these indicators is described in detail in Segal et al 40 For each indicator, we counted the occurrences of the procedure in the HRR among the population at risk in the HRR. We then identified, in the claims, the use of the procedure in those individuals.…”

“…40 The procedures spanned clinical categories and included radiologic procedures, cardiac imaging, invasive diagnostic procedures, and therapeutics. 40 The procedures spanned clinical categories and included radiologic procedures, cardiac imaging, invasive diagnostic procedures, and therapeutics.…”