Study examines overuse of ambulatory health care services in US

December 24, 2012, JAMA and Archives Journals

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."

Explore further: Study examines research on overuse of health care services

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

Related Stories

Study examines research on overuse of health care services

January 23, 2012
The overuse of health care services in the United States appears to be an understudied problem with research literature limited to a few services and rates of overuse varying widely, according to an article published in the ...

Antibiotics often the wrong prescription for pediatric asthma

June 1, 2011
(Medical Xpress) -- At nearly one in six pediatric asthma visits, antibiotics are prescribed as a remedy, despite national guidelines against the practice. Ian Paul, departments of pediatrics and public health sciences, Penn ...

Costs of neck and back conditions increasing in U.S.

September 11, 2012
(HealthDay)—For individuals with back and neck conditions, costs have increased in the last decade, with the main increase due to rising medical specialist costs, according to a study published in the Sept. 1 issue of Spine.

Federally funded clinics for low-income patients as effective as private practices

July 10, 2012
The federal government has committed $11 billion to expand the operating capacity of Federally Qualified Health Centers (FQHC), which receive federal funding and enhanced Medicaid and Medicare reimbursement, and "look-alike" ...

Recommended for you

Group suggests pushing age of adolescence to 24

January 22, 2018
A small group of researchers with the Royal Children's Hospital in Australia is suggesting that it might be time to change the span of years that define adolescence—from the current 10 to 19 to a proposed 10 to 24 years ...

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.