ArticleJAMA internal medicine2013
Trends in the overuse of ambulatory health care services in the United States.
Article in JAMA internal medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 4 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
55 citing papers in PubMed, 4 syntheses or guidelines pooled it, 107 citations in OpenAlex.
- Quality indicators assessing antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure.The Journal of antimicrobial chemotherapy · 2018Pooled it
- Are low-value care measures up to the task? A systematic review of the literature.BMC health services research · 2016Pooled it
- Advanced practice registered nurses, physician assistants and cancer prevention and screening: a systematic review.BMC health services research · 2014Pooled it
- Factors Associated With the Overuse of Colorectal Cancer Screening: A Systematic Review.American journal of medical quality : the official journal of the American College of Medical QualityPooled it
- Variation in Outcomes and Number of Visits Following Care Guideline Implementation: Part 2 of an Analysis of 12 355 Patients After Total Knee Arthroplasty.The Journal of orthopaedic and sports physical therapy · 2023Trial
- Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study.BMC health services research · 2019Trial
- Adult Patients' Perspectives on the Benefits and Harms of Overused Screening Tests: a Qualitative Study.Journal of general internal medicine · 2015Trial
- Visit-level quality measurement reveals missed opportunities and overuse in preventive oral health care.Journal of the American Dental Association (1939) · 2026Article
- Pretest Probability in Ophthalmology: Preserving Diagnostic Calibration While Moving Beyond Race.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
- Changes in Prescription Patterns and Diagnostic Outcomes of Polysomnography After Insurance Coverage: A Multicenter Retrospective Study.Journal of rhinology : official journal of the Korean Rhinologic Society · 2025Article
- Ordering of diagnostic imaging by physical therapists: a multi-center analysis of successful implementation.The Journal of manual & manipulative therapy · 2025Observational
- Evaluating the accessibility and value of U.S. ambulatory care among Medicaid expansion states and non-expansion states, 2012-2015.BMC health services research · 2023Article
- Comparison of Low-Value Care Among Commercial and Medicaid Enrollees.Journal of general internal medicine · 2023Article
- Characteristics Associated with Low-Value Cancer Screening Among Office-Based Physician Visits by Older Adults in the USA.Journal of general internal medicine · 2022Observational
- A call to action: direct access to physical therapy is highly successful in the US military. When will professional bodies, legislatures, and payors provide the same advantages to all US civilian physical therapists?The Journal of manual & manipulative therapy · 2022Review
- Addressing the Drivers of Medical Test Overuse and Cascades: User-Centered Design to Improve Patient-Doctor Communication.Joint Commission journal on quality and patient safety · 2022Article
- How Healthcare Utilization Due to Dizziness and Vertigo Differs Between Older and Younger Adults.Frontiers in medicine · 2022Article
- Overuse of Cervical Cancer Screening Tests Among Women With Average Risk in the United States From 2013 to 2014.JAMA network open · 2021Article
- Prostate-specific antigen testing among young men: an opportunity to improve value.Cancer medicine · 2021Article
- Assessment of Prevalence and Cost of Care Cascades After Routine Testing During the Medicare Annual Wellness Visit.JAMA network open · 2020Observational
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundGiven the rising costs of health care, policymakers are increasingly interested in identifying the inefficiencies in our health care system. The objective of this study was to determine whether the overuse and misuse of health care services in the ambulatory setting has decreased in the past decade.
methodsCross-sectional analysis of the 1999 and 2009 National Ambulatory Medical Care Survey and the outpatient department component of the National Hospital Ambulatory Medical Care Survey, which are nationally representative annual surveys of visits to non-federally funded ambulatory care practices. We applied 22 quality indicators using a combination of current quality measures and guideline recommendations. The main outcome measures were the rates of underuse, overuse, and misuse and their 95% CIs.
resultsWe observed a statistically significant improvement in 6 of 9 underuse quality indicators. There was an improvement in the use of antithrombotic therapy for atrial fibrillation; the use of aspirin, β-blockers, and statins in coronary artery disease; the use of β-blockers in congestive heart failure; and the use of statins in diabetes mellitus. We observed an improvement in only 2 of 11 overuse quality indicators, 1 indicator became worse, and 8 did not change. There was a statistically significant decrease in the overuse of cervical cancer screening in visits for women older than 65 years and in the overuse of antibiotics in asthma exacerbations. However, there was an increase in the overuse of prostate cancer screening in men older than 74 years. Of the 2 misuse indicators, there was a decrease in the proportion of patients with a urinary tract infection who were prescribed an inappropriate antibiotic.
conclusionsWe found significant improvement in the delivery of underused care but more limited changes in the reduction of inappropriate care. With the high cost of health care, these results are concerning.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.