Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer

Lipitz‐Snyderman, Allison; Sima, Camelia S.; Atoria, Coral L.; Elkin, Elena B.; Anderson, Christopher B.; Blinder, Victoria S.; Tsai, C. Jillian; Panageas, Katherine S.

doi:10.1001/jamainternmed.2016.4426

Cited by 49 publications

(61 citation statements)

References 35 publications

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“…27 (Table I) Nine studies used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data, 15,18-23,25,26 four studies used data from the Veterans Health Administration (VA), 14,21,24,27 and two studies used data from a single institution or system. 16,17 …”

Section: Resultsmentioning

confidence: 99%

“…All thirteen empirical studies evaluated the overuse of bone scan as an outcome. While two studies focused exclusively on bone scans, the remaining eleven studies considered bone scan in combination with up to three other imaging modalities; eleven studies examined computed tomography (CT), 15-21,23-26 eight studies examined magnetic resonance imaging (MRI), 15-17,20,21,24-26 five studies examined positron emission tomography (PET) 18,19,21,24,26 and one study examined ultrasonography. 15 (Table I) For example, an outcome may be defined as receipt of any imaging (bone scan, MRI, or PET) in an individual with early stage prostate cancer.…”

Section: Resultsmentioning

confidence: 99%

“…Five of these studies contained two separate analyses; two studies subdivided the patient population into low- and intermediate-risk individuals, 22,23 one study examined different imaging modalities separately, 20 and the other two studies asked separate but complementary research questions. 18,25 …”

Section: Resultsmentioning

confidence: 99%

“…All eleven empirical studies evaluated the effect of patient age, with six 18,20,22-24,26 of the 11 reporting a significant relationship between age and overuse. Five articles, including six analyses, found that older age was associated with overuse, 20,22-24,26 although two studies found that individuals in the oldest age category were subjected to less overuse than the youngest age group.…”

Section: Determinants Of Imaging Overusementioning

confidence: 99%

“…Five articles, including six analyses, found that older age was associated with overuse, 20,22-24,26 although two studies found that individuals in the oldest age category were subjected to less overuse than the youngest age group. 18,20 …”

Section: Determinants Of Imaging Overusementioning

confidence: 99%

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Determinants of the overuse of imaging in low-risk prostate cancer: A systematic review

Oakes

Sharma

Jackson

et al. 2017

Urologic Oncology: Seminars and Original Investigations

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Background The overuse of radiologic services, where imaging tests are provided in circumstances where the propensity for harm exceeds the propensity for benefit, comprises a risk to patient safety and a burden on health care systems. Advanced imaging in the staging of low-risk prostate cancer is considered an overused procedure by many professional societies, yet the determinants that drive this phenomenon are not fully appreciated. Methods We systematically searched published literature within MEDLINE® and Embase® from January 1998 to March 2017. We searched for studies conducted in the United States that contain original data and describe determinants associated with the overuse of imaging in low-risk prostate cancer. Paired reviewers independently screened abstracts, assessed quality, and extracted data. We synthesized the identified determinants as a patient-level, clinician-level, or system-level factors of overuse. Results Fourteen articles were included; the 13 empirical studies defined overuse as being the use of imaging that was discordant with clinical guidelines. Patient- and system-related factors were most commonly described as being associated with overuse; clinician-level determinants were examined infrequently. Older patient age (n=5), more patient comorbidities (n=7), and characteristics related to geography (n=6), higher regional income (n=6) and less education (n=5) were the most consistently identified statistically significant determinants of overuse. Meaningful differences were detected between health care settings; large integrated health care systems provided less variable care and had lower rates of overuse. Clinical indicators related to prostate cancer were inconsistently associated with overuse. Conclusion Many patient- and system-related determinants were identified as contributing to the overuse of advanced imaging to stage low-risk prostate cancer. Overuse may be the consequence of systematized clinician behavior and be relatively invariant of patient characteristics. The identified system-level determinants suggest that payment models that are not tied to volume or enhanced care coordination may curb overuse. We propose further examination of physician-level determinants and implore researchers to rank the relative importance of the identified factors and to test their influence through experimental and quasi-experimental methods.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Determinants Of Imaging Overusementioning

confidence: 99%

Section: Determinants Of Imaging Overusementioning

confidence: 99%

See 3 more Smart Citations

Determinants of the overuse of imaging in low-risk prostate cancer: A systematic review

Oakes

Sharma

Jackson

et al. 2017

Urologic Oncology: Seminars and Original Investigations

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Physician Practice Style Variation—Implications for Policy

Parys

Skinner

2016

JAMA Intern Med

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Clinician-Level Predictors for Ordering Low-Value Imaging

et al. 2017

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IMPORTANCE Clinicians who order unnecessary radiographic imaging may cause financial harm to patients who have increasing levels of cost sharing. Clinician predictors of low-value imaging are largely unknown.OBJECTIVE To characterize clinician predictors of low-value imaging for acute uncomplicated back pain and headache, including clinicians who saw both conditions. DESIGN, SETTING, AND PARTICIPANTS Multivariate logistic regression modeling of imaging rates after acute uncomplicated back pain and headache visits as indicated by January 2010 to December 2014 commercial insurance claims and demographic data from a large US health insurer. Participants included 100 977 clinicians (primary care physicians, specialist physicians, and chiropractors). MAIN OUTCOMES AND MEASURESImaging after acute uncomplicated back pain and headache visits was recorded. We identified whether the clinician's prior patient received imaging, whether the clinician was an owner of imaging equipment, and the varying impact by clinician specialty. We then used high rates of low-value back imaging as a predictor for low-value headache imaging.RESULTS Clinicians conducted 1 007 392 visits for 878 720 adults ages 18 to 64 years with acute uncomplicated back pain; 52 876 primary care physicians conducted visits for 492 805 adults ages 18 to 64 years with acute uncomplicated headache; 34 190 primary care clinicians conducted 405 721 visits for 344 991 adults ages 18 to 64 years with headache and had also conducted at least 4 visits from patients with back pain. If a primary care physician's prior patient received low-value back imaging, the patient had 1.81 higher odds of low-value imaging (95% CI, 1.77-1.85). This practice effect was larger for chiropractors (odds ratio [OR], 2.80; 95% CI, 2.74-2.86) and specialists (OR, 2.98; 95% CI, 2.88-3.07). For headache, a prior low-value head image predicted 2.00 higher odds of a subsequent head imaging order (95% CI, 1.95-2.06). Clinician ownership of imaging equipment was a consistent independent predictor of low-value imaging (OR,) across clinician type and imaging scenario. Primary care physicians with the highest rates of low-value back imaging also had 1.53 (95% CI, 1.45-1.61) higher odds of ordering low-value headache imaging.CONCLUSIONS AND RELEVANCE Clinician characteristics such as ordering low-value imaging on a prior patient, high rates of low-value imaging in another clinical scenario, and ownership of imaging equipment are strong predictors of low-value back and headache imaging. Findings should inform policies that target potentially unnecessary and financially burdensome care.

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Physician-Driven Variation in Nonrecommended Services Among Older Adults Diagnosed With Cancer

Cited by 49 publications

References 35 publications

Determinants of the overuse of imaging in low-risk prostate cancer: A systematic review

Determinants of the overuse of imaging in low-risk prostate cancer: A systematic review

Physician Practice Style Variation—Implications for Policy

Clinician-Level Predictors for Ordering Low-Value Imaging

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