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Center for Health Services and Outcomes Research

Aging

Overuse of Healthcare Resources in Older Adults

Overuse has been defined as the provision of care in circumstances where the potential for harm exceeds the potential for benefit; a phenomenon driven by a perfect storm of patient, provider, and institutional determinants. While overuse is pervasive throughout the healthcare system, older Americans may be particularly at risk, for example, this may include the use of screening tests when there are conditions causing substantial competing risks, therapies delivered at end-of-life that do not impact disease course or quality of life, therapies delivered without recognition of the heterogeneity among older patients due to frailty,  polypharmacy in multimorbid patients, and care coordination failure.

The overarching aim of this project is to work towards harm reduction for older patients through parsimonious healthcare use, and concurrently, train the next generation of researchers in this field. This project includes plans to a) systematically review the literature about determinants of overuse of healthcare resources; b) conduct a qualitative study via focus groups to understand how patients perceive overuse and its harms; c) use stated-preference methods to understand how older patients make decisions about their use of healthcare and how this varies in the presence of geriatric syndromes, and d) validate the Johns Hopkins Overuse Index (JHOI) with additional data sources and explore the impact of Accountable Care Organization establishment on overuse of resources in older patients.