Evaluation of Low-Value Diagnostic Testing for 4 Common Conditions in the Veterans Health Administration.
Evaluation of Low-Value Diagnostic Testing for 4 Common Conditions in the Veterans Health Administration.
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DOI：
10.1001/jamanetworkopen.2020.16445
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发表时间：
2020-09-01
影响因子：
13.8
通讯作者：
Gellad WF
中科院分区：
文献类型：
--
作者：
Radomski TR;Feldman R;Huang Y;Sileanu FE;Thorpe CT;Thorpe JM;Fine MJ;Gellad WF
本队列研究评估了退伍军人健康管理局对腰痛、头痛、晕厥和鼻窦炎的低价值诊断检测的频率和变化。在退伍军人健康管理局中，腰痛、头痛、晕厥和鼻窦炎的低价值诊断测试的频率和变化程度是多少？在这项对1022987名美国退伍军人的队列研究中，低价值测试被用于5%至21%的具有四种医疗条件中的一种的退伍军人。各退伍军人医疗中心在低价值测试方面存在显著差异，在退伍军人医疗中心水平上，退伍军人接受低价值测试的情况显著相关。在这项研究中，低价值的诊断测试是常见的，并且在整个退伍军人健康管理局中提供的服务各不相同，这表明有必要解决这种护理的提供问题，即使是在综合卫生系统中，也要有强有力的决策支持和利用管理。低价值护理与患者的伤害和浪费的医疗保健支出有关，但在退伍军人健康管理局尚未得到很好的表征。目的探讨退伍军人事务医疗中心（VAMCs） 4种常见疾病低价值诊断检测的频率和变化，并研究每种疾病低价值检测的接收之间的相关性。这项回顾性队列研究使用了2014 - 2015财政年度127名退伍军人健康管理局的数据。数据分析时间为2018年4月至2020年3月。在2015财政年度，退伍军人健康管理局继续登记。接受腰痛、头痛、晕厥和鼻窦炎的低价值检查。对于每种情况，使用敏感和特定的标准来评估低值测试的总体频率和范围，并根据社会人口统计学和VAMC特征进行调整。vamc水平的变异采用中位数校正优势比计算。Pearson相关系数用于评价各工况在VAMC水平上的低值检验之间的相关程度。1 022 987名退伍军人中，平均（SD）年龄为60（16）岁，男性1 008 336人（92.4%），非西班牙裔白人761 485人（69.8%）。其中腰痛343024人（31.4%），头痛79176人（7.3%），晕厥23776人（2.2%），鼻窦炎52889人（4.8%）。根据敏感标准，总体和vamc水平的低值检测频率在不同情况下差异很大：鼻窦炎4.6%（范围，2.7%-10.1%），头痛12.8%（范围，8.6%-22.6%），腰痛18.2%（范围，10.9%-24.6%），晕厥20.1%（范围，16.3%-27.7%）。根据特定的标准，VAMCs中低值检测的总体频率为鼻窦炎2.4%（范围，1.3%-5.1%），头痛8.6%（范围，6.2%-14.6%），腰痛5.6%（范围，3.6%-7.7%），晕厥13.3%（范围，11.3%-16.8%）。中位校正优势比从腰痛的1.21到鼻窦炎的1.40不等。在VAMC水平上，低值测试与晕厥和头痛的相关性最强(ρ = 0.56; P <。腰痛和头痛（ρ = 0.48; P < 0.001）。在本队列研究中，低价值诊断测试是常见的，在VAMC中差异很大，并且退伍军人在VAMC水平上接受不同低价值测试之间存在相关性。研究结果表明，即使在综合卫生系统中，也需要通过强有力的利用管理实践来解决低价值诊断检测问题。
This cohort study assesses the frequency and variation in low-value diagnostic testing for low back pain, headache, syncope, and sinusitis in the Veterans Health Administration. What is the frequency and degree of variation in low-value diagnostic testing for low back pain, headache, syncope, and sinusitis in the Veterans Health Administration? In this cohort study of 1 022 987 US veterans, low-value testing was performed for 5% to 21% of veterans with 1 of the 4 medical conditions. There was substantial variation in low-value testing across Veterans Affairs medical centers and significant correlation at the Veterans Affairs medical center level in veterans’ receipt of such testing. In this study, low-value diagnostic testing was common and delivered variably throughout the Veterans Health Administration, suggesting the need to address the delivery of such care, even in integrated health systems, with robust decision support and utilization management. Low-value care is associated with harm among patients and with wasteful health care spending but has not been well characterized in the Veterans Health Administration. To characterize the frequency of and variation in low-value diagnostic testing for 4 common conditions at Veterans Affairs medical centers (VAMCs) and to examine the correlation between receipt of low-value testing for each condition. This retrospective cohort study used Veterans Health Administration data from 127 VAMCs from fiscal years 2014 to 2015. Data were analyzed from April 2018 to March 2020. Continuous enrollment in Veterans Health Administration during fiscal year 2015. Receipt of low-value testing for low back pain, headache, syncope, and sinusitis. For each condition, sensitive and specific criteria were used to evaluate the overall frequency and range of low-value testing, adjusting for sociodemographic and VAMC characteristics. VAMC-level variation was calculated using median adjusted odds ratios. The Pearson correlation coefficient was used to evaluate the degree of correlation between low-value testing for each condition at the VAMC level. Among 1 022 987 veterans, the mean (SD) age was 60 (16) years, 1 008 336 (92.4%) were male, and 761 485 (69.8%) were non-Hispanic White. A total of 343 024 veterans (31.4%) were diagnosed with low back pain, 79 176 (7.3%) with headache, 23 776 (2.2%) with syncope, and 52 889 (4.8%) with sinusitis. With the sensitive criteria, overall and VAMC-level low-value testing frequency varied substantially across conditions: 4.6% (range, 2.7%-10.1%) for sinusitis, 12.8% (range, 8.6%-22.6%) for headache, 18.2% (range, 10.9%-24.6%) for low back pain, and 20.1% (range, 16.3%-27.7%) for syncope. With the specific criteria, the overall frequency of low-value testing across VAMCs was 2.4% (range, 1.3%-5.1%) for sinusitis, 8.6% (range, 6.2%-14.6%) for headache, 5.6% (range, 3.6%-7.7%) for low back pain, and 13.3% (range, 11.3%-16.8%) for syncope. The median adjusted odds ratio ranged from 1.21 for low back pain to 1.40 for sinusitis. At the VAMC level, low-value testing was most strongly correlated for syncope and headache (ρ = 0.56; P < .001) and low back pain and headache (ρ = 0.48; P < .001). In this cohort study, low-value diagnostic testing was common, varied substantially across VAMCs, and was correlated between veterans’ receipt of different low-value tests at the VAMC level. The findings suggest a need to address low-value diagnostic testing, even in integrated health systems, with robust utilization management practices.
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