Setting a research agenda for medical overuse

Overuse of medical services is common.1 2 3 4 5 In the United States, overuse represents as much as 30% of provided services5 6 7 8 9 and has been associated with worse outcomes and death.6 10 The problem has existed for decades,1 7 11 12 but despite heightened recognition in recent years13 14 15 16 17 18 many gaps remain in our basic understanding of its scope, drivers, and potential for harming patients physically, mentally, and financially. Recent efforts on overuse include a joint statement by the American Board of Internal Medicine and Academy Health calling for improved definitions of medical overuse,19 and the Robert Wood Johnson Foundation recommended changes in state policy to reduce overuse.20

Although the Agency for Healthcare Research and Quality (AHRQ) sponsored a report on medical overuse in 2009, this report did not delineate a framework for research.21 Research into overuse remains poorly coordinated and terms such as overuse, overdiagnosis, and low value care are all used to describe various interpretations of the concept. Without a common language or conceptual framework to connect research efforts and objectives, understanding of overuse will remain fragmented and limit our ability to make healthcare safer, less expensive, and more patient centered. Calls have been made for a research agenda.22 23 This article provides a conceptual framework organizing the current research on overuse and formulating a research agenda. It reflects the consensus opinions of a working group of clinicians and researchers convened by the Lown Institute in December 2013.