Overuse of Ambulatory Health Care Services Barely Changed in 10 Years
A new study shows that the overuse of ambulatory health care services in the United States barely changed in the decade between 1999 and 2009.
The overuse of ambulatory health care services in the United States barely changed in the decade between 1999 and 2009, according to researchers at the Icahn School of Medicine at Mount Sinai. The study results, titled "Trends in the Overuse of Ambulatory Health Care Services in the United States" were published Online First by the Archives of Internal Medicine, a JAMA Network publication.
"Given the rising costs of health care, policymakers are increasingly interested in identifying the inefficiencies in our health care system," said Minal S. Kale, MD, first author of the study and Associate of Medicine, General Internal Medicine, at the Icahn School. "Our results, which show very little decrease in the overuse and misuse of health care services in the ambulatory setting over the past decade, indicate a need to develop clinical practice guidelines that define when care should not be delivered. The creation of performance measures that address inappropriate care is a critical step to increasing the value and efficiency of our health care system."
The researchers analyzed data from the 1998, 1999, 2008 and 2009 National Ambulatory Medical Care Survey (NAMCS) and the outpatient department component of the National Hospital Ambulatory Medical Care Survey (NHAMCS), both of which are nationally representative surveys conducted annually by the Centers for Disease Control and Prevention’s National Center for Health Statistics.
The study sample included 79,083 and 102,980 unweighted visits by adult patients at least 18 years of age in 1998 to 1999, and 2008 to 2009, respectively. Compared with visits made in 1998-1999, visits in 2008-2009 were by slightly older patients (average age 54.2 years vs. 50.9 years), and more patients were insured by Medicare.
The authors found a statistically significant improvement in six of nine underuse quality indicators, including improvement in use of antithrombotic therapy for atrial fibrillation; use of aspirin, β-blockers, and statins in coronary artery disease; use of β-blockers in congestive heart failure; and the use of statins in diabetes mellitus.
The authors also observed improvement in two of 11 overuse quality indicators, which included a statistically significant decrease in cervical cancer screening among women older than 65 years, as well as a reduction in the overuse of antibiotics for asthma exacerbations. However, there was an increase in one overuse indicator, prostate cancer screening in men older than 74 years. The authors observed no changes in the other eight quality indicators during the study period.
About The Mount Sinai Medical Center
The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai. Established in 1968, the Icahn School of Medicine is one of the leading medical schools in the United States, and is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by U.S. News & World Report.
The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation’s oldest, largest and most-respected voluntary hospitals. In 2012, U.S. News & World Report ranked The Mount Sinai Hospital 14th on its elite Honor Roll of the nation’s top hospitals based on reputation, safety, and other patient-care factors. Mount Sinai is one of 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and by U.S. News & World Report and whose hospital is on the U.S. News & World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.