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Area of Science:

  • Health Services Research
  • Clinical Informatics
  • Quality Improvement

Background:

  • Low-value care represents a significant challenge in healthcare systems, contributing to increased costs and potential patient harm.
  • Electronic health records (EHRs) offer a rich data source for identifying healthcare utilization patterns, but their accuracy in detecting low-value care needs evaluation.
  • Manual chart review is a traditional method for assessing care quality, but it is resource-intensive.

Purpose of the Study:

  • To measure the overuse of low-value care services using both EHR data and manual chart review.
  • To evaluate the effectiveness of EHR data in capturing specific low-value healthcare services compared to manual review.

Main Methods:

  • Algorithms were developed to extract data on 13 Choosing Wisely-identified services from EHRs between 2011 and 2013.
  • Automated EHR extracts were used to calculate initial overuse rates.
  • Manual chart review of 200 overuse cases per measure was conducted to identify clinical risk factors, followed by calculation of adjusted overuse rates.

Main Results:

  • Unadjusted overuse rates varied widely (0.2% to 92%).
  • Manual review identified additional explanatory risk factors for some services (e.g., 22.5% for sinus CT/antibiotics in rhinosinusitis) but fewer for others (e.g., 3.0% for bone densitometry).
  • Adjusted overuse rates ranged from 0.2% to 61.9%, with eight services showing a significant decrease in overuse over three years.

Conclusions:

  • The combined use of automated EHR data extraction and manual chart review enhances the accuracy and reliability of identifying overuse of low-value healthcare services.
  • This integrated approach provides a robust method for quality improvement initiatives aimed at reducing unnecessary medical care.
  • EHR data, when appropriately validated, can be a powerful tool for monitoring and addressing low-value care.