Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments,JAMA Internal Medicine

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Development of a Conceptual Map of Negative Consequences for Patients of Overuse of Medical Tests and Treatments
JAMA Internal Medicine ( IF 22.5 ) Pub Date : 2018-10-01 , DOI: 10.1001/jamainternmed.2018.3573
Deborah Korenstein _{1,

2} , Susan Chimonas _{2,

3} , Brooke Barrow ₂ , Salomeh Keyhani _{4,

5} , Aaron Troy ₆ , Allison Lipitz-Snyderman _{2,

3}

Affiliation

Importance Overuse of medical tests and treatments is an increasingly recognized problem across health systems; best practices for reducing overuse are not clear. Framing the problem in terms of the spectrum of potential patient harm is likely to be an effective strategy for clinician and patient engagement in efforts to reduce overuse, but the scope of negative consequences of overuse for patients has not been well described. Observations We sought to generate a comprehensive conceptual map documenting the processes through which overused tests and treatments lead to multiple domains of negative consequences for patients. For map development, an iterative consensus process was informed by structured review of the literature on overuse using PubMed and input from a panel of 6 international experts. For map verification, a systematic review was performed of case reports involving overused services, identified through literature review and manual review of relevant article collections. The conceptual map documents that overused tests and treatments and resultant downstream services generate 6 domains of negative consequences for patients: physical, psychological, social, financial, treatment burden, and dissatisfaction with health care. Negative consequences can result from overused services and from downstream services; they can also trigger further downstream services that in turn can lead to more negative consequences, in an ongoing feedback loop. Case reports on overuse confirmed the processes and domains of the conceptual map. Cases also revealed strengths and weaknesses in published communication about overuse: they were dominated by physical harms, with other negative consequences receiving far less attention. Conclusions and Relevance This evidence-based conceptual map clarifies the processes by which overused tests and treatments result in negative consequences for patients; it also documents multiple domains of negative consequences experienced by patients. The map will be useful for facilitating comprehensive communication about overuse, estimating harms and costs associated with overused services, and informing health system efforts to reduce overuse.

中文翻译：

为过度使用医学测试和治疗的患者制定负面后果概念图

重要性过度使用医学检测和治疗是卫生系统日益认识到的问题；减少过度使用的最佳做法尚不清楚。从潜在的患者伤害范围来界定问题可能是临床医生和患者参与减少过度使用的有效策略，但过度使用对患者的负面影响范围尚未得到很好的描述。观察我们试图生成一个全面的概念图，记录过度使用的测试和治疗导致对患者产生多个负面影响的过程。对于地图开发，通过使用 PubMed 对过度使用的文献进行结构化审查以及来自 6 位国际专家小组的意见，形成了一个迭代共识过程。对于地图验证，对涉及过度使用服务的案例报告进行了系统审查，这些报告是通过文献审查和对相关文章集的人工审查确定的。概念图记录了过度使用的测试和治疗以及由此产生的下游服务对患者产生 6 个负面影响领域：身体、心理、社会、经济、治疗负担和对医疗保健的不满。过度使用的服务和下游服务可能会导致负面后果；它们还可以触发进一步的下游服务，从而在持续的反馈循环中导致更多的负面后果。关于过度使用的案例报告证实了概念图的过程和领域。案例还揭示了关于过度使用的公开交流的优缺点：它们主要是身体伤害，其他负面后果受到的关注要少得多。结论和相关性此基于证据的概念图阐明了过度使用测试和治疗对患者造成负面影响的过程；它还记录了患者经历的负面后果的多个领域。该地图将有助于促进关于过度使用的全面交流，估计与过度使用服务相关的危害和成本，并为卫生系统减少过度使用的努力提供信息。

更新日期：2018-10-01

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