Use and costs of nonrecommended tests during routine preventive health exams

Routine office visits for preventive health exams (PHEs) are designed to identify asymptomatic diseases at early treatable stages and influence healthy behaviors. Investigation included how often diagnostic tests and procedures were performed for which evidence and guidelines recommend against in asymptomatic individuals during routine PHEs, and the costs associated with the tests and procedures.

In 2005, a cross-sectional study of office-based interventions was conducted, using National Ambulatory Medical Care Survey (NAMCS) data from 1997 to 2002. Recommendations from the United States Preventive Services Task Force (USPSTF) were used as a measure of appropriateness of diagnostic interventions during the PHE. Laboratory tests and procedures not recommended (D ranking) included urinalysis (UAs); interventions not recommended included electrocardiograms (EKGs) and x-rays.

The frequency of ordering any of the three diagnostic interventions ranged from 5% to 37%, and at least one of the interventions was ordered 43% of the time. Annual direct costs for the three interventions range from $47 million to $194 million.

Less use of unwarranted interventions will likely eliminate waste and improve the overall quality of health care in the United States.