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The Association Between Continuity of Care and the Overuse of Medical Procedures.

ABSTRACT: Both the overuse of unnecessary medical procedures and poor continuity of care are thought to contribute to high health care spending and poor patient outcomes.To investigate the association between care continuity and use of potentially unnecessary procedures.Observational retrospective cohort (n?=?1,208,250 patients > 65 years) using 5% Medicare fee-for-service claims from 2008.We evaluated continuity using the Bice-Boxerman continuity of care index. We measured overuse using a previously validated set of 19 potentially overused procedures.Altogether, 14.7% of patients received at least 1 potentially overused procedure during the calendar year. For each 0.1 increase in the continuity score (0.4 SDs), patients had 0.93 times the odds of receiving overused procedures than those with lower scores (95% CI, 0.93-0.94). Higher continuity was significantly associated with lower odds of 9 procedures (Holm-Bonferroni corrected P?

SUBMITTER: Romano MJ

PROVIDER: S-EPMC5577558 | biostudies-literature | 2015 Jul

REPOSITORIES: biostudies-literature

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The Association Between Continuity of Care and the Overuse of Medical Procedures.

Romano Max J MJ Segal Jodi B JB Pollack Craig Evan CE

JAMA internal medicine 20150701 7

<h4>Importance</h4>Both the overuse of unnecessary medical procedures and poor continuity of care are thought to contribute to high health care spending and poor patient outcomes.<h4>Objective</h4>To investigate the association between care continuity and use of potentially unnecessary procedures.<h4>Design, setting, and participants</h4>Observational retrospective cohort (n = 1,208,250 patients > 65 years) using 5% Medicare fee-for-service claims from 2008.<h4>Main outcomes and measures</h4>We ...[more]

PMID: 25984883

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Project description:Medical overuse is a topic of growing interest in health care systems and especially in primary care. It comprises both over investigation and overtreatment. Quaternary prevention strategies aim at protecting patients from unnecessary or harmful medicine. The objective of this study was to gain a deeper understanding of relevant aspects of medical overuse in primary care from the perspective of German general practitioners (GPs). We focused on the scope, consequences and drivers of medical overuse and strategies to reduce it (=quaternary prevention).We used the qualitative Grounded Theory approach. Theoretical sampling was carried out to recruit GPs in Bavaria, Germany. We accessed the field of research through GPs with academic affiliation, recommendations by interview partners and personal contacts. They differed in terms of primary care experience, gender, region, work experience abroad, academic affiliation, type of specialist training, practice organisation and position. Qualitative in-depth face-to-face interviews with a semi-structured interview guide were conducted (n =?13). The interviews were audiotaped and transcribed verbatim. Data analysis was carried out using open and axial coding.GPs defined medical overuse as unnecessary investigations and treatment that lack patient benefit or bear the potential to cause harm. They observed that medical overuse takes place in all three German reimbursement categories: statutory health insurance, private insurance and individual health services (direct payment). GPs criticised the poor acceptance of gate-keeping in German primary care. They referred to a low-threshold referral policy and direct patient access to outpatient secondary care, leading to specialist treatment without clear medical indication. The GPs described various direct drivers of medical overuse within their direct area of influence. They also emphasised indirect drivers related to system or societal processes. The proposed strategies for reducing medical overuse included a well-founded wait-and-see approach, medical education, a trustful doctor-patient relationship, the improvement of primary/health care structures and the involvement of patients and society.GPs are frequently located at the starting point of the diagnostic and treatment process. They have the potential to play a vital role in quaternary prevention. This requires a debate going beyond the medical profession and involving society as a whole.

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The Association Between Continuity of Care and the Overuse of Medical Procedures.

Publications

The Association Between Continuity of Care and the Overuse of Medical Procedures.

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