TY - JOUR
T1 - Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement
AU - Rowe, Theresa A.
AU - Brown, Tiffany
AU - Lee, Ji Young
AU - Linder, Jeffrey A.
AU - Friedberg, Mark W.
AU - Doctor, Jason N.
AU - Meeker, Daniella
AU - Ciolino, Jody D.
AU - Persell, Stephen D.
N1 - Funding Information:
Dr. Persell receives unrelated research support from Omron Healthcare Co, LTD. and has previously received unrelated research support from Pfizer, Inc.
Funding Information:
The study was funded by grant R21AG057383 from the National Institute on Aging, National Institutes of Health.
Funding Information:
Dr. Persell, Dr. Rowe, and Ms. Lee had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Persell receives unrelated research support from Omron Healthcare Co, LTD. and has previously received unrelated research support from Pfizer, Inc. Dr. Friedberg, since 2016, has received financial support for research from the RAND Corporation, Agency for Healthcare Research and Quality, American Board of Medical Specialties Research and Education Foundation, American Medical Association, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services, Cedars-Sinai Medical Center, Commonwealth Fund, Milbank Memorial Fund, National Institute on Aging, National Institute on Drug Abuse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute on Minority Health and Health Disparities, Patient-Centered Outcomes Research Institute, and Washington State Institute for Public Policy. Since 2016, Dr. Friedberg has received payments from Consumer Reports for consulting services, from Wolters Kluwer for co-authorship of an UpToDate article about hospital quality measurement, and from Harvard Medical School for tutoring medical students in health policy. Since 2016, Dr. Friedberg has received support to attend meetings from the American Medical Association, Gordon and Betty Moore Foundation, and the United States Department of Veterans Affairs. Dr. Friedberg also has a clinical practice in primary care at Brigham and Women?s Hospital and thus receives payment for clinical services, via the Brigham and Women?s Physician Organization, from dozens of commercial health plans and government payers, including but not limited to Medicare, Medicaid, Blue Cross and Blue Shield of Massachusetts, Tufts Health Plan, and Harvard Pilgrim Health Plan, which are the most prevalent payers in Massachusetts. The study was funded by grant R21AG057383 from the National Institute on Aging, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent views of the National Institutes of Health. The funder had no role in the design, collection, or interpretation of data or in the decision to submit for publication.
Publisher Copyright:
© 2020, Society of General Internal Medicine.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Importance: The extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood. Objective: To examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults. Design: Retrospective analysis of overall means and clinician-level variation in performance on three new measures. Subjects: Adults aged 65 years and older who had office visits with outpatient primary or immediate care clinicians within a single academic medical center health system between July 1, 2016, and June 30, 2017. Measures: Two electronic clinical quality measures representing potentially inappropriate use of medical services in older adults: prostate-specific antigen testing against guidelines (PSA) in men aged 76 and older; urinalysis or urine culture for non-specific reasons in women aged 65 and older; and one intermediate outcome measure: hemoglobin A1c less than 7.0 in adults aged 75 and older with diabetes mellitus treated with insulin or oral hypoglycemic medication. Results: Sixty-nine clinicians and 2009 patients contributed observations to the PSA measure, 144 clinicians and 5933 patients contributed to the urinalysis/urine culture measure, and 42 clinicians and 665 patients contributed to the diabetes measure. Meaningful clinician-level performance variation was greatest for the PSA measure (intraclass correlation coefficient [ICC] = 0.27), followed by the urinalysis/urine culture measure (ICC = 0.18), and the diabetes measure (ICC = 0.024). The range of possible overuse across clinician quartiles was 8–54% for the PSA measure, 3–35% for the urinalysis/urine culture measure, and 13–49% for the diabetes measure. The odds ratios of overuse in the highest quartile compared with the lowest for the PSA, urinalysis/urine culture, and diabetes measures were 99.3 (95% CI 43 to 228), 15.7 (10 to 24), and 6.0 (3.3 to 11), respectively. Conclusions: Within the same health system, rates of potential overuse in elderly patients varied greatly across clinicians, particularly for the process measures examined.
AB - Importance: The extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood. Objective: To examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults. Design: Retrospective analysis of overall means and clinician-level variation in performance on three new measures. Subjects: Adults aged 65 years and older who had office visits with outpatient primary or immediate care clinicians within a single academic medical center health system between July 1, 2016, and June 30, 2017. Measures: Two electronic clinical quality measures representing potentially inappropriate use of medical services in older adults: prostate-specific antigen testing against guidelines (PSA) in men aged 76 and older; urinalysis or urine culture for non-specific reasons in women aged 65 and older; and one intermediate outcome measure: hemoglobin A1c less than 7.0 in adults aged 75 and older with diabetes mellitus treated with insulin or oral hypoglycemic medication. Results: Sixty-nine clinicians and 2009 patients contributed observations to the PSA measure, 144 clinicians and 5933 patients contributed to the urinalysis/urine culture measure, and 42 clinicians and 665 patients contributed to the diabetes measure. Meaningful clinician-level performance variation was greatest for the PSA measure (intraclass correlation coefficient [ICC] = 0.27), followed by the urinalysis/urine culture measure (ICC = 0.18), and the diabetes measure (ICC = 0.024). The range of possible overuse across clinician quartiles was 8–54% for the PSA measure, 3–35% for the urinalysis/urine culture measure, and 13–49% for the diabetes measure. The odds ratios of overuse in the highest quartile compared with the lowest for the PSA, urinalysis/urine culture, and diabetes measures were 99.3 (95% CI 43 to 228), 15.7 (10 to 24), and 6.0 (3.3 to 11), respectively. Conclusions: Within the same health system, rates of potential overuse in elderly patients varied greatly across clinicians, particularly for the process measures examined.
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U2 - 10.1007/s11606-020-05748-8
DO - 10.1007/s11606-020-05748-8
M3 - Article
C2 - 32128687
AN - SCOPUS:85081622343
SN - 0884-8734
VL - 35
SP - 1797
EP - 1802
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 6
ER -
