Nav: Home

Patients at hospital-based primary practices more likely to get unnecessary tests

April 10, 2017

Patients with common conditions such as back pain, headaches and upper respiratory infections are more likely to receive tests and services of uncertain or little diagnostic or therapeutic benefit--so-called low-value care--when they seek treatment in primary care clinics located at hospitals rather than at community-based primary care clinics, according to a nationwide study led by researchers at Harvard Medical School and the David Geffen School of Medicine at UCLA.

The key factor driving this disparity appears to be clinic location rather than clinic ownership, the research showed. Indeed, aside from referring patients to specialists slightly more often, hospital-owned community clinics delivered care otherwise similar to physician-owned community clinics.

The study findings, published April 10 in JAMA Internal Medicine, found an overreliance on referrals to specialists, CT scans, MRIs and X-rays in patients treated at hospital-based primary care practices, raising concerns about the value of hospital-based primary care, the research team said.

Over-testing and unnecessary referrals are serious concerns because past research shows that up to one-third of medical care may be wasteful or unnecessary. Unnecessary care can not only fuel higher overall treatment costs and spending but also lead to additional invasive and potentially harmful procedures and, in the case of CT scans and X-ray testing, expose patients to unnecessary radiation, the researchers say.

Insights from the study could help hospital-based practices develop strategies that limit the use of tests and procedures that provide little value for patients while driving up health care costs.

"Hospital-based practices need to be aware of their tendency to overuse certain tests and services of questionable therapeutic value for patients with uncomplicated conditions," said study senior author Bruce Landon, an HMS professor of health care policy and of medicine at Beth Israel Deaconess Medical Center, where he practices general internal medicine. "That knowledge can help both frontline clinicians and hospital leaderships find ways to eliminate or at least reduce such unnecessary services."

The researchers say their findings suggest that more immediate access to specialists and the proximity and convenience of imaging services in hospitals may drive physicians in such settings to overuse them.

"An estimated 10 to 30 percent of health care spending in the United States stems from services that provide low-value care," said first author John Mafi, an assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA. "Reducing the use of such services can not only help curb health care costs--and redirect such resources in more meaningful way--but also protect patients from the potentially harmful effects associated with such services."

Common examples of low-value care include prescribing antibiotics for a patient with the common cold or other viral upper respiratory infection not affected by antibiotics, or sending a patient with uncomplicated back pain or headache for an MRI or a CT scan.

In their analysis, the team compared patient records obtained from two national databases, comprising more than 31,000 patient visits over a 17-year period during which patients sought treatment in hospital-based primary care clinics or community-based clinics for upper respiratory infections, back pain and headaches.

In order to better identify patients for whom the services were likely of low value, the researchers excluded those with more complex symptoms suggestive of a more serious disorder as well as people with underlying disorders and chronic conditions.

Antibiotic prescription rates were similar in community- and hospital-based clinics.

However, hospital-treated patients were referred more often for MRIs and CT scans (8 percent, compared with 6 percent) than community-treated patients, more often for X-ray testing (13 percent, compared with 9 percent) and more often for an evaluation by a specialist (19 percent, compared with 7.6 percent).

Additionally, the patients most likely to receive unnecessary tests and services were those visiting hospital-based primary care clinics but seeing someone other than their usual primary care physician. The finding, the researchers say, highlights the importance of continuity of care and suggests that when patients bounce from physician to physician they may be more likely to be over-tested or over-treated.

"Not seeing your regular primary care physician--what we call discontinuity of care--might be a weak spot where low value care can creep in," Landon said. "The more we know about what situations are most likely to lead to patients' receiving low-value care, the more we can do to prevent it."
-end-
Co-authors on the study include Christina Wee, HMS associate professor of medicine at Beth Israel Deaconess Medical Center, and Roger Davis, associate professor of medicine (biostatistics) at Beth Israel Deaconess and associate professor of biostatistics at the Harvard T.H. Chan School of Public Health.

This research was supported with funding from the National Institutes of Health (Midcareer Mentorship Award K24DK087932 and Harvard Catalyst National Institutes of Health Award UL1 TR001102).

Release written by Jake Miller

Harvard Medical School

Harvard Medical School has more than 11,000 faculty working in 10 academic departments located at the School's Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Massachusetts Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Network and VA Boston Healthcare System.

Harvard Medical School

Related Ct Scans Articles:

New technique makes brain scans better
To help scientists take advantage of huge numbers of low-quality patient brain scans, a team of MIT researchers has devised a way to boost the quality of these MRI scans so that they can be used for large scale studies of how strokes affect different people.
New many-toothed clingfish discovered with help of digital scans
Scientists at the University of Washington, Texas A&M University and the Western Australian Museum have discovered and named a new genus and species of clingfish after stumbling upon a specimen preserved in a jar dating back to the 1970s.
MRI scans can help spot HIV in the brain
Scientists at UCL have developed a way to use MRI scans to help identify when HIV is persisting in the brain despite effective drug treatment.
High-resolution brain scans could improve concussion detection
Simon Fraser University researchers have found that high-resolution brain scans, coupled with computational analysis, could play a critical role in helping to detect concussions that conventional scans might miss.
CT scans reveal birds' built-in air conditioners
Birds' beaks come in an incredible range of shapes and sizes, adapted for survival in environments around the world.
Roadmap to get new cancer scans into clinic
A team of international scientists has outlined key recommendations for a global standard for scanning biomarkers in cancer -- to bridge the gap between research and the clinic, according to a new paper published in Nature Reviews Clinical Oncology today.
Meaning of brain scans for 'pain' called into question
Patterns of brain activity thought to show pain responses have been called into question after researchers saw such patterns in rare patients born without a sense of pain.
New imaging scans track down persistent cancer cells
Head and neck cancer patients may no longer have to undergo invasive post-treatment surgery to remove remaining cancer cells, as research shows that innovative scanning-led surveillance can help identify the need for, and guidance of, neck dissection.
Ultra-low dose CT scans successfully detect fractures
Researchers at NYU Langone Medical Center are reporting they successfully performed CT scans for joint fractures with one-fourteenth the amount of normal radiation without compromising image quality or a surgeon's ability to effectively diagnose an injury.
No proof that radiation from X rays and CT scans causes cancer
The widespread belief that radiation from X rays, CT scans and other medical imaging can cause cancer is based on an unproven, decades-old theoretical model, according to a study published in the American Journal of Clinical Oncology.

Related Ct Scans Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...