Volume 12, Issue 5 p. 346-351
Choosing Wisely®: Next Steps in Improving Healthcare Value

A Practical Framework for Understanding and Reducing Medical Overuse: Conceptualizing Overuse Through the Patient-Clinician Interaction

Daniel J. Morgan MD, MS

Daniel J. Morgan MD, MS

VA Maryland Healthcare System, University of Maryland School of Medicine and Centers for Disease Dynamics, Economics, and Policy, Baltimore, Maryland

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Aaron L. Leppin MD, MS

Aaron L. Leppin MD, MS

Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota

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Cynthia D. Smith MD

Cynthia D. Smith MD

American College of Physicians, Philadelphia, Pennsylvania

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Deborah Korenstein MD

Corresponding Author

Deborah Korenstein MD

Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York

Address for correspondence and reprint requests: Deborah Korenstein, MD, Department of Medicine, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, New York, NY 10017; Telephone: 646-888-8139; Fax: 646-227-7102; E-mail: [email protected]Search for more papers by this author
First published: 01 May 2017
Citations: 61

Abstract

Overuse of medical services is an increasingly recognized driver of poor-quality care and high cost. A practical framework is needed to guide clinical decisions and facilitate concrete actions that can reduce overuse and improve care. We used an iterative, expert-informed, evidence-based process to develop a framework for conceptualizing interventions to reduce medical overuse. Given the complexity of defining and identifying overused care in nuanced clinical situations and the need to define care appropriateness in the context of an individual patient, this framework conceptualizes the patient–clinician interaction as the nexus of decisions regarding inappropriate care. This interaction is influenced by other utilization drivers, including healthcare system factors, the practice environment, the culture of professional medicine, the culture of healthcare consumption, and individual patient and clinician factors. The variable strength of the evidence supporting these domains highlights important areas for further investigation.