The relationship between geographic variations and overuse of healthcare services: a systematic review

Medical Care
Salomeh KeyhaniDeborah Korenstein

Abstract

To examine the relationship between overuse of healthcare services and geographic variations in medical care. Systematic Review. Articles published in Medline between 1978, the year of publication of the first framework to measure quality, and January 1, 2009. Four investigators screened 114,830 titles and 2 investigators screened all selected abstracts and articles for possible inclusion and extracted all data. We extracted data on rates of overuse in different geographic areas. We also extracted data on underuse, if available, for the same population in which overuse was measured. Five papers examined the relationship between geographic variations and overuse of healthcare services. One study in 2008 compared the appropriateness of coronary angiography (CA) for acute myocardial infarction in high-cost areas versus low cost areas in the Medicare population and found largely similar rates of inappropriateness (12.2% vs. 16.2%). A study in 2000 using national data concluded that overuse of CA explained little of the geographic variations in the use of this procedure in the Medicare program. An older study of Medicare patients found similar rates of inappropriate use of CA (15% to 17% vs. 18%), endoscopy (15% vs. 18% 19%), and ca...Continue Reading

References

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