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Updated: Jul 4, 2025

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Reducing Care Overuse in Older Patients Using Professional Norms and Accountability : A Cluster Randomized Controlled

Stephen D Persell1, Lucia C Petito2, Ji Young Lee3

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Clinical decision support tools reduced overuse of prostate-specific antigen (PSA) testing and nonspecific urine tests in older adults. The intervention also decreased diabetes overtreatment but may increase rates of uncontrolled diabetes.

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Area of Science:

  • Geriatric Medicine
  • Health Services Research
  • Behavioral Science

Background:

  • Overuse of medical tests and treatments in older adults can lead to harm.
  • Effective strategies are needed to reduce unnecessary healthcare utilization.

Purpose of the Study:

  • To evaluate the impact of clinician decision support on reducing overuse in older primary care patients.
  • To assess the effects of decision support focusing on potential harms, social norms, and reputational concerns.

Main Methods:

  • An 18-month, pragmatic, cluster randomized trial involving 60 primary care practices.
  • Intervention group received decision support tools and case-based education; control group received education alone.
  • Outcomes measured included rates of prostate-specific antigen (PSA) testing, unspecified urine testing, and diabetes overtreatment.

Main Results:

  • The intervention group showed significantly lower rates of PSA testing (-8.7%), unspecified urine testing (-5.5%), and diabetes overtreatment (-1.4%) compared to the control group.
  • No increase in emergency care for urinary tract infections or hyperglycemia was observed.
  • A slight increase in HbA1c >9.0% was noted in previously overtreated diabetes patients within the intervention group (+0.47%).

Conclusions:

  • Decision support effectively reduced unnecessary testing and diabetes overtreatment in older adults.
  • While generally safe, the intervention requires careful monitoring for potential increases in uncontrolled diabetes.
  • Findings suggest that behavioral science-informed decision support can modify clinician behavior to reduce overuse.