ArticleJournal of general internal medicine2020
Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement.
Article in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 9 citations in OpenAlex.
- Variation in Low-Value Service Use Across Veterans Affairs Facilities.Journal of general internal medicine · 2023Article
- Development and pilot testing of EHR-nudges to reduce overuse in older primary care patients.Archives of gerontology and geriatrics · 2023Article
- Association of hemoglobin A1c time in range with risk for diabetes complications.BMJ open diabetes research & care · 2022Observational
- General practitioners' reflections on using PSA for diagnosis of prostate cancer. A qualitative study.Scandinavian journal of primary health care · 2022Article
- Design of Behavioral Economic Applications to Geriatrics Leveraging Electronic Health Records (BEAGLE): A pragmatic cluster randomized controlled trial.Contemporary clinical trials · 2022Article
- Examining primary care physician rationale for not following geriatric choosing wisely recommendations.BMC family practice · 2021Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
Abstract
importanceThe extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood.
objectiveTo examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults.
designRetrospective 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.
resultsSixty-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.
conclusionsWithin 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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