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Review
. 2017 May;12(5):346-351.
doi: 10.12788/jhm.2738.

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

Daniel J Morgan  1 , Aaron L Leppin  2 , Cynthia D Smith  3 , Deborah Korenstein  4
Affiliations
Review

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

Daniel J Morgan et al. J Hosp Med. 2017 May.

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. Journal of Hospital Medicine 2017;12:346-351.

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Conflict of interest statement

Potential Conflicts of Interest: DJM has provided a self-developed lecture in a 3M sponsored series on hospital epidemiology and received honoraria for serving as a book and journal editor from Springer Publishing. CDS is employed by the American College of Physicians. She owns stock in Merck and Co where her husband is employed. The other authors report no potential conflicts of interest.

Figures

Figure
Figure. Framework for understanding and reducing overuse
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References

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