Performance measures neglect healthcare overuse

Hospital performance measures do not pay enough attention to overuse, according to a new study published in JAMA Internal Medicine.

Researchers, led by Erika Newton, M.D., of Stony Brook Medicine, and Brenda Sirovich, M.D., of the Dartmouth Institute, analyzed 16 collections of data encompassing 521 outpatient performance measures. Of these, more than 90 percent addressed care underuse while only 7 percent involved overuse. Nearly half of the collections contained no measures relating to overuse.

"Our findings suggest that, by focusing almost single-mindedly on identifying and penalizing underuse, current outpatient performance measures may well foster a culture of 'more is better'--and inadvertently encourage overuse of care," Newton said in a statement.

Despite this imbalance, the authors wrote, existing performance measurement systems are well-suited to address both overuse and underuse. By developing and implementing measure collections or individual measures that encompass both ends of the spectrum, healthcare leaders can pioneer a "Goldilocks approach" in which providers and clinicians seek to create a "just right" level of care between overuse and underuse.

Previous research on care overuse has analyzed demographics and causes. For example, research earlier this year found that while race and ethnicity do not correlate with overuse, heavy concentrations of overuse exist among white patients, FierceHealthcare previously reported. Reinforcing Newton and Sirovich's concerns, however, the researchers noted that the low quality and relative rarity of existing research on the topic made it difficult to draw conclusions.

Meanwhile, a February study indicated overuse occurs in response to patient requests only 1 percent of the time, suggesting poor communication between patients and providers may be the driving factor, according to FiercePracticeManagement.

To learn more:
- here's the study abstract
- read the statement