ArticleJournal of hospital medicine2021
Development of a Simple Index to Measure Overuse of Diagnostic Testing at the Hospital Level Using Administrative Data.
Article in Journal of hospital medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.
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Who cites it
6 citing papers in PubMed, 1 synthesis or guideline pooled it, 7 citations in OpenAlex.
- Patient, provider, and system-level factors associated with preoperative cardiac testing: A systematic review.Journal of hospital medicine · 2023Pooled it
- Breaking the guidelines: how financial unawareness fuels guideline deviations and inefficient DVT diagnostics.Diagnosis (Berlin, Germany) · 2025Article
- Race and Ethnicity and Diagnostic Testing for Common Conditions in the Acute Care Setting.JAMA network open · 2024Article
- Development of a disease-based hospital-level diagnostic intensity index.Diagnosis (Berlin, Germany) · 2024Article
- Characterizing the Relationship Between Payer Mix and Diagnostic Intensity at the Hospital Level.Journal of general internal medicine · 2022Article
- Characterizing the relationship between diagnostic intensity and quality of care.Diagnosis (Berlin, Germany) · 2021Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveWe developed a diagnostic overuse index that identifies hospitals with high levels of diagnostic intensity by comparing negative diagnostic testing rates for common diagnoses.
methodsWe prospectively identified candidate overuse metrics, each defined by the percentage of patients with a particular diagnosis who underwent a potentially unnecessary diagnostic test. We used data from seven states participating in the State Inpatient Databases. Candidate metrics were tested for temporal stability and internal consistency. Using mixed-effects ordinal regression and adjusting for regional and hospital characteristics, we compared results of our index with three Dartmouth health service area-level utilization metrics and three Medicare county-level cost metrics.
resultsThe index was comprised of five metrics with good temporal stability and internal consistency. It correlated with five of the six prespecified overuse measures. Among the Dartmouth metrics, our index correlated most closely with physician reimbursement, with an odds ratio of 2.02 (95% CI, 1.11-3.66) of being in a higher tertile of the overuse index when comparing tertiles 3 and 1 of this Dartmouth metric. Among the Medicare county-level metrics, our index correlated most closely with standardized costs of procedures per capita, with an odds ratio of 2.03 (95% CI, 1.21-3.39) of being in a higher overuse index tertile when comparing tertiles 3 and 1 of this metric.
conclusionsWe developed a novel overuse index that is preliminary in nature. This index is derived from readily available administrative data and shows some promise for measuring overuse of diagnostic testing at the hospital level.
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