Audit‐based measures of overuse of medical care in Australian hospital practice. Issue 7 (11th July 2019)

• Record Type: Journal Article
• Authors: Scott, Ian A.
• Is Part Of: Internal medicine journal. Volume 49:Issue 7(2019)
• Page Start: 893
• Page End: 904
• Publication Date: 2019-07-11
• Subjects: overuse -- medical care -- hospital practice; Medicine -- Periodicals; 616
• DOI: 10.1111/imj.14346
• Languages: English
• ISSNs: 1444-0903

Abstract

Abstract: Overuse of care that does not confer benefit to patients and wastes limited resources is being increasingly recognised as a major healthcare problem. The preferred measure of overuse of a specific intervention is applying an evidence‐ or consensus‐based measure of inappropriateness directly to the medical records of individual patients who have received the intervention. This study aimed to assess the extent of overuse of care in hospital practice in Australia based on peer‐reviewed literature that reported clinical audits using explicit measures of overuse applied to patient‐level clinical data. Thirty‐five studies met selection criteria, 14 relating to investigations, 21 to management strategies. Overuse rates above 30% were reported for coagulation tests, blood cultures, troponin assays, abdominal imaging studies, use of telemetry, blood product infusions, polypharmacy in older patients, prescriptions for various medications (gastric acid suppressants, direct oral anticoagulants, inhaled corticosteroids), admissions for low‐risk chest pain and futile interventions in end of life care. Hospital physicians may need to audit their current high‐volume practices and ensure they align with current criteria of appropriateness.