Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries

Ganguli, Ishani; Lupo, Claire; Mainor, Alexander J; Raymond, Stephanie; Wang, Qianfei; Orav, E. John; Chang, Chiang‐Hua; Morden, Nancy E.; Rosenthal, Meredith B.; Colla, Carrie H.; Sequist, Thomas D.

doi:10.1001/jamainternmed.2019.1739

Cited by 75 publications

(115 citation statements)

References 58 publications

(154 reference statements)

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“…9,32 One-third of physicians in our survey reported that the initial test in their most recently experienced cascade may not have been clinically appropriate: harms are unlikely to be offset by any benefits from testing in such cases. 2,10…”

Section: Discussionmentioning

confidence: 99%

Cascades of Care After Incidental Findings in a US National Survey of Physicians

et al. 2019

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Section: Discussionmentioning

confidence: 99%

Cascades of Care After Incidental Findings in a US National Survey of Physicians

et al. 2019

Self Cite

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“…This approach may misclassify testing performed for indications other than preoperative testing during the specified time period and may miss preoperative testing performed for a planned procedure that did not ultimately occur. 22 , 25 , 26 …”

Section: Methodsmentioning

confidence: 99%

Trends in Low-Value Carotid Imaging in the Veterans Health Administration From 2007 to 2016

et al. 2020

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Key Points Question How has utilization of low-value carotid imaging for carotid bruits, preoperative evaluation, and syncope changed in the Veterans Health Administration system from 2007 to 2016? Findings In this serial cross-sectional study of 809 071 carotid imaging examinations in the national Veterans Affairs Health system, there was a modest decrease in rates of imaging for carotid bruits that predated Choosing Wisely recommendations, and no significant trends in rates of preoperative carotid imaging or imaging for syncope. Meaning These findings suggest that to reduce low-value testing and utilization cascades, interventions targeting ordering clinicians are needed to augment the impact of public awareness campaigns.

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“…26,29 A strength of this study is the use of EHR data to explore downstream impacts of a common nonindicated laboratory test within a large health system, similar to that which has been performed with other lowvalue care services. 47,48 We are not aware of other published studies that have examined downstream consequences of low-value vitamin D tests. Although individual chart review was not performed in this study, Isaac et al 40 recently observed only minor differences in low-value care services identified via automated EHR search and individual chart review.…”

Section: Quality Of Carementioning

confidence: 99%

Patterns of Clinical Care Subsequent to Nonindicated Vitamin D Testing in Primary Care

Rockwell

Salamoun

et al. 2020

J Am Board Fam Med

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Background: Exponential increases in nonindicated, low-value vitamin D testing have been reported over the past 15 years. Downstream effects of such testing have not been well quantified. Methods: The purpose of this study was to describe patterns of vitamin D testing within primary care of a large regional health system and to explore downstream health service utilization subsequent to nonindicated testing. Instances of vitamin D testing in 2015 were obtained by an electronic health record-automated search. A subset of patients for whom vitamin D testing was classified as nonindicated was identified, and vitamin D-related service utilization was tracked for 24 months. Results: Of the 77,836 adult primary care patient records identified in 2015, vitamin D tests were conducted on 8,042 (10.3%), with 24.3% of tests yielding abnormal results. In the nonindicated test subset (n = 574), substantial clinical variability was illustrated by 85 care pathways and 26 vitamin D prescriptions. Forty-five percent of abnormal vitamin D lab tests were not followed up with repeat vitamin D tests. Vitamin D-related services (laboratory tests, imaging, and prescriptions) occurred at an average rate of 1.6 services per patient during the 24 months following nonindicated vitamin D testing. Some of these services were also classified as nonindicated. Conclusions: Evidence of a health service cascade following nonindicated vitamin D testing exists. Opportunities for improved consistency and quality of care related to vitamin D were observed in our health system. These results may inform clinical pathways related the prevention, evaluation, and treatment of low vitamin D.

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Prevalence and Cost of Care Cascades After Low-Value Preoperative Electrocardiogram for Cataract Surgery in Fee-for-Service Medicare Beneficiaries

Cited by 75 publications

References 58 publications

Cascades of Care After Incidental Findings in a US National Survey of Physicians

Cascades of Care After Incidental Findings in a US National Survey of Physicians

Trends in Low-Value Carotid Imaging in the Veterans Health Administration From 2007 to 2016

Patterns of Clinical Care Subsequent to Nonindicated Vitamin D Testing in Primary Care

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