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Many screening and diagnostic tests often offer little
benefit and sometimes cause harm
PHILADELPHIA, January 17, 2012 -- Common clinical scenarios can
result in better health outcomes if physicians and patients discuss
the benefits and harms of screening and diagnostics tests that are
often unnecessary or might cause harm, according to a paper
published today in Annals of Internal Medicine.
"Appropriate Use of Screening and Diagnostic Tests to Foster
High Value, Cost-Conscious Care" is an opinion article published by
a group of physicians from the American College of Physicians
(ACP). The authors reviewed the evidence and identified 37 common
clinical situations relevant to internal medicine in which
screening and diagnostic tests are often used in ways that provide
little or no benefit to patients.
"We hope to promote thoughtful discussions among physicians,
patients, and other stakeholders about common clinical scenarios in
which there are opportunities to improve the quality of care for
the benefit of patients," said co-author Steven Weinberger, MD,
FACP, executive vice president and CEO of ACP. "Wasteful and
duplicative practices that do not improve patient health -- and
might even cause harm -- are unfortunately all too common and an
important component of escalating, unsustainable health care
Physicians, other health care professionals, and members of the
public can complete a brief web survey on www.annals.org to indicate whether they
agree that each of the items represents low value care. Survey
respondents can also indicate clinical situations that they would
add to the list
In an accompanying editorial, Christine Laine, MD, FACP, editor
of Annals of Internal Medicine, says that the time is
right to discuss how to achieve health care savings and improve the
quality of care through more thoughtful use of an ever increasing
array of tests.
"Physicians, whether they agree or disagree with the ACP
workgroup's or other groups' lists of overused interventions, can
improve the value of testing by asking themselves a few common
sense questions before ordering any test," Dr. Laine writes. "Too
often, we order tests without stopping to think about how (if at
all) the result will help the patient. A few moments of reflection
before test ordering could reduce the human and financial costs of
low value testing."
By some estimates from the Congressional Budget Office, up to 30
percent of health care costs are spent on care that is duplicative
or unnecessary and may not improve people's health.
ACP launched a High Value,
Cost-Conscious Care initiative in 2010 to help physicians
provide the best possible care to their patients while
simultaneously reducing unnecessary health care costs. ACP defines
high value, cost-conscious care as the delivery of services
providing benefits that make their harms and costs worthwhile.
Value is not merely cost. Some expensive tests and treatments
have high value because they provide high benefit and low harm.
Conversely, some inexpensive tests or treatments have low value
because they do not provide enough benefit to justify even their
low costs and might even be harmful.
"Like ACP's Best Practice Advice paper for diagnostic imaging
for low back pain, we plan to continue to produce
evidence-based recommendations and educate clinicians and patients
about how to pursue care together that improves health, avoids
harms, and eliminates wasteful practices," Dr. Weinberger said.
The American College of Physicians is the largest medical
specialty organization and the second-largest physician group in
the United States. ACP members include 132,000 internal medicine
physicians (internists), related subspecialists, and medical
students. Internists specialize in the prevention, detection, and
treatment of illness in adults. Follow ACP on Twitter and Facebook.