1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Med Care Res Rev. 2013 Oct;70(5):473-96. doi: 10.1177/1077558713492202. Epub 2013 Jun 26.
Health care overuse contributes to unnecessary expenditures and patient exposure to harm. Understanding and addressing this problem requires a comprehensive set of valid metrics. This article describes and critiques the current state of overuse measurement through a review of the published and gray literature, measures clearinghouses and ongoing work by major measure developers. Our review identified 37 fully specified measures and 123 measurement development opportunities. Many services were considered overuse due to the extension of diagnostic or screening services to low-risk populations. There were more diagnostic or therapeutic overuse measures than for screening or monitoring/surveillance. Imaging services is a major focus of current measures, but opportunities exist to expand overuse measurement in medication, laboratory services. Future development of overuse measures would benefit from new empirical research and clinical guidelines focused on identifying indications or populations for which there is likely to be no or low benefit.
医疗保健过度使用导致不必要的支出和患者受到伤害。理解和解决这个问题需要一套全面的有效指标。本文通过对已发表和灰色文献、度量衡中心以及主要度量衡制定者正在进行的工作的审查，描述和批评了过度使用的测量现状。我们的审查确定了 37 个完全指定的度量标准和 123 个度量开发机会。许多服务被认为是过度使用，因为将诊断或筛查服务扩展到低风险人群。诊断或治疗过度使用的措施比筛查或监测/监视多。成像服务是当前措施的主要关注点，但在药物、实验室服务方面，仍有机会扩大过度使用的测量。未来过度使用措施的发展将受益于新的实证研究和临床指南，重点是确定可能没有或低收益的适应症或人群。
