Temporal trends and regional variation in the utilization of low-value breast cancer care: has the Choosing Wisely campaign made a difference?
Temporal trends and regional variation in the utilization of low-value breast cancer care: has the Choosing Wisely campaign made a difference?
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DOI：
10.1007/s10549-019-05213-z
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发表时间：
2019-07-01
影响因子：
3.8
通讯作者：
Pezzin, Liliana E.
中科院分区：
文献类型：
--
作者：
Neuner, Joan M.;Nattinger, Ann B.;Pezzin, Liliana E.
自2012年以来，约有80个专业协会发布了明智选择（CW）建议，旨在减少使用低价值，未经证实或无效的医疗服务。这些建议在多大程度上影响了医生和患者的行为仍然在很大程度上unknowed.MethodsUsing MarketScan商业索赔和医疗保险的补充和协调的福利数据库，我们确定了每年一批的妇女与事件，早期乳腺癌和估计的患病率四个初始治疗和6个监测指标被认为是低价值的乳腺癌护理CW。随后使用多变量Logistic回归估计时间趋势和区域变化，在使用这些指标，特别关注CW的publishation.ResultsThere年确定为122,341名妇女接受治疗的事件乳腺癌在2010年和2014年之间。四个低值初始治疗指标中的两个和六个低值监测指标中的四个随时间显著下降。然而，使用减少的时间趋势是在化学武器准则发布之前出现的。下降范围从随访乳房X线摄影的11.0%到接受手术活检而未尝试针吸活检的40.6%。有显着的区域差异，在使用低价值的乳腺癌护理的所有指标，其中大部分持续出版后的CW.ConclusionsWith两个显着的例外，使用低价值的乳腺癌护理稳步下降，自2010年以来。然而，这种下降并没有因为《化学武器公约》建议的公布而加速。
PurposeSince 2012, about 80 specialty societies have released Choosing Wisely (CW) recommendations aimed at reducing the use of low-value, unproven, or ineffective medical services. The extent to which these recommendations have influenced the behavior of physicians and patients remains largely unknown.MethodsUsing MarketScan Commercial Claims and Medicare Supplemental and Coordination of Benefits databases, we identified annual cohorts of women with incident, early-stage breast cancer and estimated the prevalence of four initial treatment and six surveillance metrics deemed as low-value breast cancer care by CW. Multivariable logistic regressions were subsequently used to estimate temporal trends and regional variation in the use of these metrics, with a special focus on the year of CW's publication.ResultsThere were 122,341 women identified as undergoing treatment for incident breast cancer between 2010 and 2014. Two of the four low-value initial treatment metrics and four of the sixlow-value surveillance metrics declined significantly over time. The temporal trend of declining use, however, preceded the release of CW's guidelines. Declines ranged from 11.0% for follow-up mammography to 40.6% for receipt of surgical biopsy without an attempted needle biopsy. There were marked regional differences in use of low-value breast cancer care for all metrics, much of which persisted after publication of CW.ConclusionsWith two notable exceptions, use of low-value breast cancer care has declined steadily since 2010. The declines, however, were not accelerated by the publication of CW recommendations.