Use of decision support tools reduces low-value care from clinicians seeing older patients

Use of decision support tools reduces low-value care from clinicians seeing older patients

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2183         

Editorial: https://www.acpjournals.org/doi/10.7326/M24-3501         

URL goes live when the embargo lifts   

A study of 371 primary care physicians and older patients at 60 clinics found that the use of point-of-care clinical decision support tools and education reduced instances of low-value care for patients aged 65 years and older. The study is published in Annals of Internal Medicine.

The overuse of low-value, unnecessary care remains a problem in American health care. Professional organizations have launched campaigns to raise awareness of these harms for physicians, but these practices stubbornly persist with variations across regions and health systems.

Researchers from Northwestern University Feinberg School of Medicine conducted an 18-month, single-blind, pragmatic, cluster randomized trial, with constrained randomization to evaluate the effects of a clinician decision support tool on care overuse among older patients. The trial included 371 primary care clinicians and their older adult patients from 60 primary care internal medicine, family medicine and geriatrics practices from September 2020 through February 2022. The authors delivered behavioral science–informed, point-of-care, clinical decision support tools plus brief case-based education addressing three categories of unnecessary testing in older adults: Prostate-specific antigen (PSA) testing in men aged 76 years and older without previous prostate cancer, urine testing for nonspecific reasons in women aged 65 years and older, and overtreatment of diabetes with hypoglycemic agents in patients aged 75 years and older and hemoglobin A1c (HbA1c) less than 7%. They found that the use of clinical decision support tools and education reduced all three categories of unnecessary testing more than interventions only focusing on education. According to the authors, these findings suggest that point-of-care behaviorally informed interventions can reduce overuse among older patients of primary care clinicians while preserving clinician discretion.

The author of an accompanying editorial from Johns Hopkins University discusses how various scientists, including behavioral, economists, and organizational theorists approach the complex problem of health care overuse. The author says that in their practice, the scientists at Johns Hopkins have been operationalizing points of intervention to reduce overuse using an agentic-structural framework considering both micro- and macro-level interventions that require different levels of work on the part of all affected by the issue. They look forward to additional randomized trials that test solutions to reducing low-value care.

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with the corresponding author, Stephen D. Persell, MD, MPH, please contact Marla Paul at [email protected].