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Center for Health Services and Outcomes Research

Innovative Methods â€“ New Tools

Developing an Indicator of Overuse of Medical Testing to Reduce the Cost of Health Care

The goal of this project was to develop a health service overuse index, based on claims-based specifications for selected high priority overused procedures and tests, which can be used for monitoring and determining the effectiveness of health care interventions, policy implementation and quality improvement programs. Our project team performed a comprehensive review of the literature to develop a conceptual model for the project, collate existing overuse measures and identify new opportunities to measure overuse. An expert/stakeholder panel was convened to contribute to the development of the conceptual model.

We operationalized specifications for 35 overuse indicators at the individual level using 2008 Medicare Part A and B data. We also constructed an aggregate measure of overuse by determining if a beneficiary had overused any of the 35 procedures or services,  and conducted analyses to examine the association between overuse and mortality rates, total Medicare expenditures for 2008, and utilization rates for four services (knee arthroplasty, hip arthroplasty, coronary artery bypass graft, and percutaneous transluminal coronary angioplasty).   

Products:

Chan KS, Chang E, Nassery N, Chang HY, Segal JB. (2013) The State of Overuse Measurement: A Critical Review. Medical Care Research and Review 70:473-496.

Segal JB, Nassery N, Chang HY, Chang E, Chan K, Bridges J. (2015) An Index for Measuring Overuse of Healthcare Resources with Medicare Claims. Medical Care;53(3):230-236.

Segal J, Bridges J, Chang HY, Chang E, Nassery N, Weiner J, Chan KS. (2014) Identifying Possible Indicators of Systematic Overuse of Healthcare Procedures with Claims Data. Medical Care 52(2):157-63.