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Posted: October 14th, 2020

Reducing Diagnostic Testing Variation and Overuse

Reducing Diagnostic Testing Variation and Overuse

Diagnostic testing is an essential component of healthcare, as it can help diagnose, monitor, and treat various conditions. However, diagnostic testing can also be overused, meaning that tests are performed when they are not clinically indicated or appropriate. Overuse of diagnostic testing can lead to unnecessary costs, harms, and inefficiencies in the healthcare system.

According to a systematic review by Müskens et al. (2022), the prevalence of diagnostic testing overuse ranged from 0.09% to 97.5%, with a median prevalence of 11% for assessments using a patient-indication lens, 2% for assessments using a patient-population lens, and 30.7% for assessments using a service lens. The most common types of tests that were overused were diagnostic imaging tests, such as X-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans. The most frequent indications for overuse were preoperative testing and imaging for uncomplicated low back pain.

The reasons for diagnostic testing overuse are complex and multifactorial, involving factors at the individual, organizational, and system levels. Some of the possible drivers of overuse include clinical uncertainty, defensive medicine, patient expectations and preferences, financial incentives, lack of guidelines or adherence to guidelines, and cognitive biases. Reducing diagnostic testing overuse requires a multifaceted approach that addresses these factors and involves various stakeholders, such as clinicians, patients, policymakers, payers, and researchers.

Several interventions have been proposed or implemented to reduce diagnostic testing overuse, such as clinical decision support tools, audit and feedback, education, shared decision making, financial incentives or disincentives, peer comparison, and public reporting. However, the evidence on the effectiveness and cost-effectiveness of these interventions is limited and inconsistent. More research is needed to identify the best practices and strategies to reduce diagnostic testing overuse and improve the quality and value of healthcare.

References
: Müskens JLJM, Kool RB, van Dulmen SA, Westert GP. Overuse of diagnostic testing in healthcare: a systematic review. BMJ Qual Saf. 2022;31(1):54-66. https://qualitysafety.bmj.com/content/31/1/54
: Segal JB et al. Assessment of Overuse of Medical Tests and Treatments at US Hospitals Using Medicare Claims. JAMA Netw Open. 2021;4(3):e211095. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779118
: Oeffinger KC et al. Helping Doctors “Do No Harm” by Addressing Medical Test Overuse. Memorial Sloan Kettering Cancer Center Newsroom. 2019. https://www.mskcc.org/news/helping-doctors-do-no-harm-addressing-medical-test-overuse
: Colla CH et al. Interventions aimed at reducing use of low-value health services: a systematic review. Med Care Res Rev. 2017;74(5):507-550. https://pubmed.ncbi.nlm.nih.gov/27402662/

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