Study examines overuse of ambulatory health care services in US

December 24, 2012 in Health

An analysis of nationally representative survey data found significant improvement in the delivery of underused care, but more limited changes in the reduction of inappropriate care in ambulatory health care settings between 1998 and 2009, according to a report published Online First by Archives of Internal Medicine.

"Given the rising costs of , policymakers are increasingly interested in identifying the inefficiencies in our ," the authors write as background. "The objective of this study was to determine whether the overuse and misuse of health care services in the ambulatory setting has decreased in the past decade."

Minal S. Kale, M.D., with Mt. Sinai School of Medicine, New York, and colleagues conducted an analysis using data from the 1998, 1999, 2008 and 2009 National Ambulatory Medical Care Survey (NAMCS) and the outpatient department component of the National Hospital Ambulatory Medical Care Survey (NHAMCS), both of which are nationally representative surveys conducted annually by the 's National Center for Health Statistics.

The study sample included 79,083 and 102,980 unweighted visits by adult patients at least 18 years of age in 1998 to 1999, and 2008 to 2009, respectively. Compared with visits made in 1998-1999, visits in 2008-2009 were by slightly older patients (average age 54.2 years vs. 50.9 years), and more patients were insured by Medicare.

The authors found a statistically significant improvement in six of nine underuse quality indicators, including improvement in use of antithrombotic therapy for atrial fibrillation; use of aspirin, β-blockers, and statins in ; use of β-blockers in ; and the use of statins in diabetes mellitus.

The authors also observed improvement in two of 11 overuse quality indicators, which included a statistically significant decrease in cervical cancer screening among women older than 65 years, as well as a reduction in the overuse of antibiotics for asthma exacerbations. However, there was an increase in one overuse indicator, prostate cancer screening in men older than 74 years. The authors observed no changes in the other eight quality indicators during the study period.

"In our examination of ambulatory care in the United States, we found an improvement in most of the underuse measures but limited changes in the delivery of ," the authors conclude. "Developing clinical practice guidelines that define when care should not be delivered and performance measures to address inappropriate care are critical steps to advance the mission of increasing the value and efficiency of health care delivery."

More information: Arch Intern Med. Published online December 24, 2012. doi:10.1001/2013.jamainternmed.1022

Journal reference: JAMA Internal Medicine search and more info website

Provided by JAMA and Archives Journals search and more info website

not rated yet  

Rank not rated yet
Relevant PhysicsForums posts

More news stories

It's not your imagination: Memory gets muddled at menopause

Don't doubt it when a woman harried by hot flashes says she's having a hard time remembering things. A new study published online in Menopause, the journal of The North American Menopause Society (NAMS), helps confirm with o ...

Health created 24 minutes ago | popularity not rated yet | comments 0

Farm bill: Senate rejects GMO labeling amendment

The Senate has overwhelmingly rejected an amendment allowing states to require labeling of genetically modified foods.

Health created 55 minutes ago | popularity not rated yet | comments 1

McDonald's can't shake criticism about nutrition

(AP)—McDonald's once again faced criticism that it's a purveyor of junk food that markets to children at its annual shareholder meeting Thursday.

Health created 1 hour ago | popularity not rated yet | comments 0

Economic incentives increase blood donation without negative consequences

Can economic incentives such as gift cards, T-shirts, and time off from work motivate members of the public to increase their donations of blood?

Health created 3 hours ago | popularity not rated yet | comments 0 | with audio podcast

Adult day services for dementia patients provide stress relief to family caregivers

Family caregivers of older adults with dementia are less stressed and their moods are improved on days when dementia patients receive adult day services (ADS), according to Penn State researchers.

Health created 5 hours ago | popularity not rated yet | comments 0


Controlling mood through the motions of mitochondria

(Medical Xpress)—Regulating the distribution of power in neurons is done by a system that makes the national electric grid look simple by comparison. Each neuron has several thousand mitochondria confined ...

Research identifies a way to make cancer cells more responsive to chemotherapy

Breast cancer characterized as "triple negative" carries a poor prognosis, with limited treatment options. In some cases, chemotherapy doesn't kill the cancer cells the way it's supposed to. New research from Western University ...

Mayo Clinic genomic analysis lends insight to prostate cancer

Mayo Clinic researchers have used next generation genomic analysis to determine that some of the more aggressive prostate cancer tumors have similar genetic origins, which may help in predicting cancer progression. The findings ...

Shortage of key drug hampering U.S. efforts to control TB, report says

(HealthDay)—A shortage of a critical tuberculosis drug has hampered the efforts of health departments across the United States to contain the spread of the highly infectious lung disease, federal officials ...

Heart healthy lifestyle may cut kidney disease patients' risk of kidney failure

Maintaining a heart healthy lifestyle may also help protect chronic kidney disease patients from developing kidney failure and dying prematurely, according to a study appearing in an upcoming issue of the Journal of the Am ...

Merck ends development of Parkinson's disease drug

(AP)—Merck & Co. says it is ending development of an experimental Parkinson's disease drug because the drug wasn't working.