A paper just released by The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement® (PCPI offers approaches to minimize overuse of five common medical treatments. Overuse has been described as the provision of medical interventions or treatments that provide zero or negligible benefit to patients, potentially exposing them to the risk of harm. Overuse also drives up health care costs, with an estimated $1 billion spent annually on unnecessary antibiotics for adults with viral upper respiratory infections alone.
The paper “Proceedings from the National Summit on Overuse,” provides detailed recommendations on curbing overuse of the five identified medical interventions or treatment as well as an overview of the 2012 National Summit on Overuse that brought together representatives from 112 professional organizations and associations. The five advisory panel work groups that tackled the five areas of overuse are suggesting common strategies to inspire physician leadership, support a culture of safety and mindfulness, promote further patient education, remove incentives that encourage overuse, encourage further study and spur other professional organizations to collaboratively address overuse.
The five treatments and the recommendations for further initiatives include:
- Antibiotic use for viral upper respiratory infection. Develop clinical definitions for viral and bacterial upper respiratory infections, align current national guidelines that are currently contradictory, partner with the U.S. Centers for Disease Control and Prevention (CDC), and initiate a national education campaign on overuse of antibiotics for viral upper respiratory infections.
- Appropriate blood management. Develop a tool kit of clinical education materials for doctors, expand education on ways to avoid transfusions and implement appropriate alternatives to transfusion, and develop a separate informed consent process for transfusion that communicates the risks and benefits.
- Tympanostomy tubes for middle ear effusion of brief duration. Develop performance measures for appropriate use of tympanostomy tubes, determine the frequency with which tympanostomy tubes are performed for inappropriate indications in otherwise healthy children, and focus national research on issues related to tympanostomy tubes, including the role of shared decision making with parents and other caregivers.
- Early-term non-medically indicated elective delivery. Standardize how gestational age is calculated, make the early elective deliveries indications and exclusion list as comprehensive as possible to improve clinical practice, and, educate patients and doctors about the risks of non-medically indicated early elective deliveries.
- Elective percutaneous coronary intervention. Encourage standardized reporting in the catheterization and interventional procedures report, encourage standardized analysis/interpretation of non-invasive testing for ischemia, focus on informed consent and promote patient knowledge/understanding of the benefits/risks of PCI, and provide public and professional education.
Click here to read the entire report.
Because overuse is a serious problem that involves many complex decisions between doctors and patients, the recommendations from the summit will raise awareness that will help both doctors and patients make better decisions going forward, and ultimately improve quality and patient safety.
Aside from the five procedures identified in this document, what other procedures might be good candidates for interventions to minimize their use?
The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement. Proceedings from the National Summit on Overuse, September 24, 2012. Published online July 8, 2013. http://www.jointcommission.org/assets/1/6/National_Summit_Overuse.pdf