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A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the
Daniel J Morgan1, Aaron L Leppin2, Cynthia D Smith3
1VA Maryland Healthcare System, University of Maryland School of Medicine and Centers for Disease Dynamics, Economics, and Policy, Baltimore, MD.
Journal of Hospital Medicine
|May 2, 2017
Summary
Developing a framework to reduce medical overuse is crucial for improving care quality and lowering healthcare costs. This framework focuses on the patient-clinician interaction, considering various influencing factors to guide interventions.
Area of Science:
- Health Services Research
- Medical Quality Improvement
Background:
- Medical service overuse is a significant contributor to suboptimal care quality and escalating healthcare expenditures.
- A structured approach is necessary to guide clinical decision-making and implement effective strategies for reducing overuse.
Purpose of the Study:
- To develop a practical, evidence-based framework for conceptualizing interventions aimed at reducing medical overuse.
- To identify key drivers influencing decisions regarding inappropriate medical care.
Main Methods:
- An iterative, expert-informed, and evidence-based process was employed to construct the framework.
- The framework conceptualizes the patient-clinician interaction as central to decisions about care appropriateness.
Main Results:
- The framework identifies the patient-clinician interaction as the core decision point for inappropriate care.
- Multiple factors influencing this interaction were identified, including healthcare system, practice environment, professional and patient cultures, and individual patient/clinician characteristics.
- The varying strength of evidence across these domains indicates areas for future research.
Conclusions:
- The developed framework provides a structured approach to understanding and addressing medical overuse.
- It highlights the complexity of overuse and the need for multifaceted interventions targeting the patient-clinician relationship and broader systemic factors.
- Further research is warranted to strengthen the evidence base for interventions across identified domains.
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