Published in:
01-06-2020 | Urinalysis | Original Research
Clinician-Level Variation in Three Measures Representing Overuse Based on the American Geriatrics Society Choosing Wisely Statement
Authors:
Theresa A. Rowe, DO, MS, Tiffany Brown, MPH, Ji Young Lee, MS, Jeffrey A. Linder, MD, MPH, Mark W. Friedberg, MD, MPP, Jason N. Doctor, PhD, Daniella Meeker, PhD, Jody D. Ciolino, PhD, Stephen D. Persell, MD, MPH
Published in:
Journal of General Internal Medicine
|
Issue 6/2020
Login to get access
Abstract
Importance
The extent of clinician-level variation in the overuse of testing or treatment in older adults is not well understood.
Objective
To examine clinician-level variation for three new measures of potentially inappropriate use of medical services in older adults.
Design
Retrospective analysis of overall means and clinician-level variation in performance on three new measures.
Subjects
Adults aged 65 years and older who had office visits with outpatient primary or immediate care clinicians within a single academic medical center health system between July 1, 2016, and June 30, 2017.
Measures
Two electronic clinical quality measures representing potentially inappropriate use of medical services in older adults: prostate-specific antigen testing against guidelines (PSA) in men aged 76 and older; urinalysis or urine culture for non-specific reasons in women aged 65 and older; and one intermediate outcome measure: hemoglobin A1c less than 7.0 in adults aged 75 and older with diabetes mellitus treated with insulin or oral hypoglycemic medication.
Results
Sixty-nine clinicians and 2009 patients contributed observations to the PSA measure, 144 clinicians and 5933 patients contributed to the urinalysis/urine culture measure, and 42 clinicians and 665 patients contributed to the diabetes measure. Meaningful clinician-level performance variation was greatest for the PSA measure (intraclass correlation coefficient [ICC] = 0.27), followed by the urinalysis/urine culture measure (ICC = 0.18), and the diabetes measure (ICC = 0.024). The range of possible overuse across clinician quartiles was 8–54% for the PSA measure, 3–35% for the urinalysis/urine culture measure, and 13–49% for the diabetes measure. The odds ratios of overuse in the highest quartile compared with the lowest for the PSA, urinalysis/urine culture, and diabetes measures were 99.3 (95% CI 43 to 228), 15.7 (10 to 24), and 6.0 (3.3 to 11), respectively.
Conclusions
Within the same health system, rates of potential overuse in elderly patients varied greatly across clinicians, particularly for the process measures examined.