IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
IQ healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
BMJ Qual Saf. 2022 Jan;31(1):54-63. doi: 10.1136/bmjqs-2020-012576. Epub 2021 May 10.
Overuse of diagnostic testing substantially contributes to healthcare expenses and potentially exposes patients to unnecessary harm. Our objective was to systematically identify and examine studies that assessed the prevalence of diagnostic testing overuse across healthcare settings to estimate the overall prevalence of low-value diagnostic overtesting.
PubMed, Web of Science and Embase were searched from inception until 18 February 2020 to identify articles published in the English language that examined the prevalence of diagnostic testing overuse using database data. Each of the assessments was categorised as using a patient-indication lens, a patient-population lens or a service lens.
118 assessments of diagnostic testing overuse, extracted from 35 studies, were included in this study. Most included assessments used a patient-indication lens (n=67, 57%), followed by the service lens (n=27, 23%) and patient-population lens (n=24, 20%). Prevalence estimates of diagnostic testing overuse ranged from 0.09% to 97.5% (median prevalence of assessments using a patient-indication lens: 11.0%, patient-population lens: 2.0% and service lens: 30.7%). The majority of assessments (n=85) reported overuse of diagnostic testing to be below 25%. Overuse of diagnostic imaging tests was most often assessed (n=96). Among the 33 assessments reporting high levels of overuse (≥25%), preoperative testing (n=7) and imaging for uncomplicated low back pain (n=6) were most frequently examined. For assessments of similar diagnostic tests, major variation in the prevalence of overuse was observed. Differences in the definitions of low-value tests used, their operationalisation and assessment methods likely contributed to this observed variation.
Our findings suggest that substantial overuse of diagnostic testing is present with wide variation in overuse. Preoperative testing and imaging for non-specific low back pain are the most frequently identified low-value diagnostic tests. Uniform definitions and assessments are required in order to obtain a more comprehensive understanding of the magnitude of diagnostic testing overuse.
过度使用诊断检测在很大程度上增加了医疗保健费用，并可能使患者面临不必要的伤害。我们的目标是系统地识别和研究评估医疗保健环境中诊断检测过度使用的研究，以估计低价值过度诊断检测的总体流行率。
从建库到 2020 年 2 月 18 日，我们在 PubMed、Web of Science 和 Embase 上检索以英文发表的使用数据库数据评估诊断检测过度使用流行率的文章，纳入使用患者指征镜、患者人群镜或服务镜评估诊断检测过度使用的研究。
本研究纳入了 35 项研究中的 118 项诊断检测过度使用评估，其中大多数评估使用了患者指征镜（n=67，57%），其次是服务镜（n=27，23%）和患者人群镜（n=24，20%）。诊断检测过度使用的流行率估计值为 0.09%至 97.5%（使用患者指征镜、患者人群镜和服务镜评估的评估中位数流行率分别为 11.0%、2.0%和 30.7%）。大多数评估（n=85）报告诊断检测过度使用率低于 25%。最常评估的是诊断影像学检查过度使用（n=96）。在报告高过度使用水平（≥25%）的 33 项评估中，最常检查的是术前检查（n=7）和非复杂性腰痛的影像学检查（n=6）。对于相似的诊断性检查，观察到过度使用的流行率存在很大差异。低价值检测的使用、实施和评估方法的定义不同，可能导致了这种观察到的差异。
我们的研究结果表明，诊断检测的过度使用程度较大，且差异较大。术前检查和非特异性腰痛的影像学检查是最常被确定的低价值诊断检测。需要统一的定义和评估方法，以便更全面地了解诊断检测过度使用的程度。
