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Development of a Simple Index to Measure Overuse of Diagnostic Testing at the Hospital Level Using Administrative Data
- Source :
- J Hosp Med
- Publication Year :
- 2021
- Publisher :
- Wiley, 2021.
-
Abstract
- OBJECTIVE: We developed a diagnostic overuse index that identifies hospitals with high levels of diagnostic intensity by comparing negative diagnostic testing rates for common diagnoses. METHODS: We 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. RESULTS: The 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. CONCLUSIONS: We 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.
- Subjects :
- medicine.medical_specialty
Index (economics)
Leadership and Management
030204 cardiovascular system & hematology
Assessment and Diagnosis
Medicare
Ordinal regression
03 medical and health sciences
0302 clinical medicine
Physicians
Humans
Medicine
030212 general & internal medicine
Medical diagnosis
Care Planning
Aged
Original Research
Measure (data warehouse)
Diagnostic Tests, Routine
business.industry
Health Policy
Diagnostic test
Hospital level
General Medicine
Odds ratio
Hospitals
United States
Benchmarking
Emergency medicine
Fundamentals and skills
Metric (unit)
business
Subjects
Details
- ISSN :
- 15535606 and 15535592
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- Journal of Hospital Medicine
- Accession number :
- edsair.doi.dedup.....c29b7d4538b6ecc4a66afa16a11ebd79