*Department of Medicine, Johns Hopkins University School of Medicine †Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
Med Care. 2014 Feb;52(2):157-63. doi: 10.1097/MLR.0000000000000052.
Health care quality is frequently described with measures representing the overall performance of a health care system. Despite the growing attention to overuse of health care resources, there is little experience with aggregate measures of overuse.
To identify a set of possible indicators of overuse that can be operationalized with claims data and to describe variation in these indicators across the hospital referral regions (HRRs).
Using an environmental scan, we identified published descriptions of overused procedures. We assessed each procedure's feasibility for measurement with claims and developed algorithms for occurrences of procedures in patients unlikely to benefit. Using a 5% sample of Medicare claims from 2008, we calculated summary statistics to illustrate variance in the use across HRRs.
A total of 613 procedures were identified as overused; 20 had abundant frequency and variance to be possible measures of systematic overuse. These included 13 diagnostic tests, 2 tests for screening, 1 for monitoring, and 4 therapeutic procedures. The usage varied markedly across HRRs. For illustration, 1 HRR used computed tomography for rhinosinusitis diagnosis in 80 of 1000 beneficiaries (mean usage across HRRs was 14/1000). Among 1,451,142 beneficiaries, 14% had at least one overuse event (range, 8.4%-27%).
We identified a set of overused procedures that may be used as measures of overuse and that demonstrate significant variance in their usage. The implication is that an index of overuse might be built from these indicators that would reveal systematic patterns of overuse within regions. Alternatively, these indicators may be valuable in the quality improvement efforts.
医疗保健质量通常用代表医疗保健系统整体绩效的指标来描述。尽管人们越来越关注医疗保健资源的过度使用，但对于过度使用的综合指标却鲜有经验。
确定一组可通过索赔数据操作的过度使用指标，并描述这些指标在医院转诊区域（HRR）之间的差异。
我们通过环境扫描确定了已发表的过度治疗程序描述。我们评估了每种程序使用索赔进行测量的可行性，并为不太可能受益的患者制定了程序发生的算法。我们使用 2008 年医疗保险索赔的 5%样本计算了汇总统计数据，以说明 HRR 之间使用的差异。
确定了 613 种被认为是过度使用的程序；其中 20 种具有丰富的频率和变化，可作为系统过度使用的可能衡量标准。其中包括 13 项诊断性测试、2 项筛查性测试、1 项监测性测试和 4 项治疗性程序。这些程序的使用在 HRR 之间差异显著。例如，1 个 HRR 在 1000 名受益人中的 80 人（HRR 之间的平均使用量为 14/1000）中使用计算机断层扫描（CT）诊断鼻窦炎。在 1451142 名受益人中，14%的人至少有一次过度使用事件（范围为 8.4%-27%）。
我们确定了一组可能被用作过度使用衡量标准的过度使用程序，并且这些程序的使用存在显著差异。这意味着可以从这些指标构建一个过度使用指数，该指数将揭示区域内过度使用的系统模式。或者，这些指标可能在质量改进工作中具有价值。
