Variability and Costs of Low-Value Preoperative Testing for Cataract Surgery Within the Veterans Health Administration
The Choosing Wisely guidelines indicate that preoperative testing is often unnecessary and wasteful for patients undergoing cataract operations. However, little is known about the impact of these widely disseminated guidelines within the US Veterans Health Administration (VHA) system. To examine the...
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| description | The Choosing Wisely guidelines indicate that preoperative testing is often unnecessary and wasteful for patients undergoing cataract operations. However, little is known about the impact of these widely disseminated guidelines within the US Veterans Health Administration (VHA) system.
To examine the extent, variability, associated factors, and costs of low-value tests (LVTs) prior to cataract operations in the VHA.
This cohort study examined records of all patients receiving cataract operations within the VHA in fiscal year 2017 (October 1, 2016, to September 31, 2017). Records from 135 facilities nationwide supporting both ambulatory and inpatient surgery were included.
A laboratory test occurring within 30 days prior to cataract surgery and within 30 days after clinic evaluation.
Overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days prior to cataract surgery. The patient characteristics, procedure type, and facility-level factors associated with receiving at least 1 test, the number of tests received, and receipt of a bundle of 4 tests (complete blood count, basic metabolic profile, chest radiograph, and electrocardiogram).
A total of 69 070 cataract procedures were identified among 50 106 patients (66 282 [96.0%] men; mean [SD] age, 71.7 [8.1] years; 53 837 [77.9%] White, 10 292 [14.9%] Black). Most of the patient population had either overweight (23 292 [33.7%] patients) or obesity (27 799 [40.2%] patients). Approximately 49% of surgical procedures (33 424 procedures) were preceded by 1 or more LVT with an overall LVT cost of $2 597 623. Among patients receiving LVTs, electrocardiography (7434 patients [29.9%]) was the most common, with some patients also receiving more costly tests, including chest radiographs (489 patients [8.2%]) and pulmonary function tests (127 patients [3.4%]). For receipt of any LVT, the intraclass correlation coefficient was 0.61 (P |
| doi_str_mv | 10.1001/jamanetworkopen.2021.7470 |
| format | Article |
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To examine the extent, variability, associated factors, and costs of low-value tests (LVTs) prior to cataract operations in the VHA.
This cohort study examined records of all patients receiving cataract operations within the VHA in fiscal year 2017 (October 1, 2016, to September 31, 2017). Records from 135 facilities nationwide supporting both ambulatory and inpatient surgery were included.
A laboratory test occurring within 30 days prior to cataract surgery and within 30 days after clinic evaluation.
Overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days prior to cataract surgery. The patient characteristics, procedure type, and facility-level factors associated with receiving at least 1 test, the number of tests received, and receipt of a bundle of 4 tests (complete blood count, basic metabolic profile, chest radiograph, and electrocardiogram).
A total of 69 070 cataract procedures were identified among 50 106 patients (66 282 [96.0%] men; mean [SD] age, 71.7 [8.1] years; 53 837 [77.9%] White, 10 292 [14.9%] Black). Most of the patient population had either overweight (23 292 [33.7%] patients) or obesity (27 799 [40.2%] patients). Approximately 49% of surgical procedures (33 424 procedures) were preceded by 1 or more LVT with an overall LVT cost of $2 597 623. Among patients receiving LVTs, electrocardiography (7434 patients [29.9%]) was the most common, with some patients also receiving more costly tests, including chest radiographs (489 patients [8.2%]) and pulmonary function tests (127 patients [3.4%]). For receipt of any LVT, the intraclass correlation coefficient was 0.61 (P < .001) at the facility level and 0.06 (P < .001) at the surgeon level, indicating the substantial contribution of the facility to amount of tests given.
Despite existing guidelines, use of LVTs prior to cataract surgery is both common and costly within a large, national integrated health care system. Our results suggest that publishing evidence-based guidelines alone-such as the Choosing Wisely campaign-may not sufficiently influence individual physician behavior, and that system-level efforts to directly deimplement LVTs may therefore necessary to effect sustained change.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2021.7470</identifier><identifier>PMID: 33956131</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Anesthesiology ; Cataract Extraction - adverse effects ; Cohort Studies ; Costs ; Diagnostic Tests, Routine - economics ; Electrocardiography - economics ; Eye surgery ; Female ; Health Care Costs ; Humans ; Low-Value Care ; Male ; Medical Overuse - economics ; Online Only ; Original Investigation ; Patients ; Postoperative Complications - prevention & control ; Radiography, Thoracic - economics ; Respiratory Function Tests - economics ; United States ; United States Department of Veterans Affairs - economics ; Veterans Health Services - economics</subject><ispartof>JAMA network open, 2021-05, Vol.4 (5), p.e217470-e217470</ispartof><rights>2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2021 Mudumbai SC et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a470t-b472e9ae75cd0aba3787ee2659b164a46f96bf20826d3be819b43af7bd8dfa2f3</citedby><cites>FETCH-LOGICAL-a470t-b472e9ae75cd0aba3787ee2659b164a46f96bf20826d3be819b43af7bd8dfa2f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33956131$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mudumbai, Seshadri C</creatorcontrib><creatorcontrib>Pershing, Suzann</creatorcontrib><creatorcontrib>Bowe, Tom</creatorcontrib><creatorcontrib>Kamal, Robin N</creatorcontrib><creatorcontrib>Sears, Erika D</creatorcontrib><creatorcontrib>Hawn, Mary T</creatorcontrib><creatorcontrib>Eisenberg, Dan</creatorcontrib><creatorcontrib>Finlay, Andrea K</creatorcontrib><creatorcontrib>Hagedorn, Hildi</creatorcontrib><creatorcontrib>Harris, Alex H S</creatorcontrib><title>Variability and Costs of Low-Value Preoperative Testing for Cataract Surgery Within the Veterans Health Administration</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>The Choosing Wisely guidelines indicate that preoperative testing is often unnecessary and wasteful for patients undergoing cataract operations. However, little is known about the impact of these widely disseminated guidelines within the US Veterans Health Administration (VHA) system.
To examine the extent, variability, associated factors, and costs of low-value tests (LVTs) prior to cataract operations in the VHA.
This cohort study examined records of all patients receiving cataract operations within the VHA in fiscal year 2017 (October 1, 2016, to September 31, 2017). Records from 135 facilities nationwide supporting both ambulatory and inpatient surgery were included.
A laboratory test occurring within 30 days prior to cataract surgery and within 30 days after clinic evaluation.
Overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days prior to cataract surgery. The patient characteristics, procedure type, and facility-level factors associated with receiving at least 1 test, the number of tests received, and receipt of a bundle of 4 tests (complete blood count, basic metabolic profile, chest radiograph, and electrocardiogram).
A total of 69 070 cataract procedures were identified among 50 106 patients (66 282 [96.0%] men; mean [SD] age, 71.7 [8.1] years; 53 837 [77.9%] White, 10 292 [14.9%] Black). Most of the patient population had either overweight (23 292 [33.7%] patients) or obesity (27 799 [40.2%] patients). Approximately 49% of surgical procedures (33 424 procedures) were preceded by 1 or more LVT with an overall LVT cost of $2 597 623. Among patients receiving LVTs, electrocardiography (7434 patients [29.9%]) was the most common, with some patients also receiving more costly tests, including chest radiographs (489 patients [8.2%]) and pulmonary function tests (127 patients [3.4%]). For receipt of any LVT, the intraclass correlation coefficient was 0.61 (P < .001) at the facility level and 0.06 (P < .001) at the surgeon level, indicating the substantial contribution of the facility to amount of tests given.
Despite existing guidelines, use of LVTs prior to cataract surgery is both common and costly within a large, national integrated health care system. Our results suggest that publishing evidence-based guidelines alone-such as the Choosing Wisely campaign-may not sufficiently influence individual physician behavior, and that system-level efforts to directly deimplement LVTs may therefore necessary to effect sustained change.</description><subject>Anesthesiology</subject><subject>Cataract Extraction - adverse effects</subject><subject>Cohort Studies</subject><subject>Costs</subject><subject>Diagnostic Tests, Routine - economics</subject><subject>Electrocardiography - economics</subject><subject>Eye surgery</subject><subject>Female</subject><subject>Health Care Costs</subject><subject>Humans</subject><subject>Low-Value Care</subject><subject>Male</subject><subject>Medical Overuse - economics</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Patients</subject><subject>Postoperative Complications - prevention & control</subject><subject>Radiography, Thoracic - economics</subject><subject>Respiratory Function Tests - economics</subject><subject>United States</subject><subject>United States Department of Veterans Affairs - economics</subject><subject>Veterans Health Services - economics</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkV1r2zAUhsVYWUvXvzA0drMbZ_qwZftmUEK3DgIbtE0vxbF9nCizpUySU_LvJ9OudL2SQO95dF4eQj5ytuCM8S87GMFifHD-t9ujXQgm-KLMS_aGnImizDNZseLti_spuQhhxxgTjMtaFe_IqZR1objkZ-SwBm-gMYOJRwq2o0sXYqCupyv3kK1hmJD-8ph-8hDNAekthmjshvbO0yVE8NBGejP5DfojvTdxayyNW6RrjGnEBnqNMMQtvexGY02IM8bZ9-SkhyHgxdN5Tu6-Xd0ur7PVz-8_lperDFKhmDV5KbAGLIu2Y9CALKsSUaiibrjKIVd9rZpesEqoTjZY8brJJfRl01VdD6KX5-TrI3c_NSN2Ldq0wKD33ozgj9qB0f-_WLPVG3fQFWdSiCIBPj8BvPszpe56NKHFYUgO3BS0KIRQQlaKpeinV9Gdm7xN9bRQqqxkIs7A-jHVeheCx_55Gc70LFi_EqxnwXoWnGY_vGzzPPlPp_wLPKep3Q</recordid><startdate>20210503</startdate><enddate>20210503</enddate><creator>Mudumbai, Seshadri C</creator><creator>Pershing, Suzann</creator><creator>Bowe, Tom</creator><creator>Kamal, Robin N</creator><creator>Sears, Erika D</creator><creator>Hawn, Mary T</creator><creator>Eisenberg, Dan</creator><creator>Finlay, Andrea K</creator><creator>Hagedorn, Hildi</creator><creator>Harris, Alex H S</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210503</creationdate><title>Variability and Costs of Low-Value Preoperative Testing for Cataract Surgery Within the Veterans Health Administration</title><author>Mudumbai, Seshadri C ; 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However, little is known about the impact of these widely disseminated guidelines within the US Veterans Health Administration (VHA) system.
To examine the extent, variability, associated factors, and costs of low-value tests (LVTs) prior to cataract operations in the VHA.
This cohort study examined records of all patients receiving cataract operations within the VHA in fiscal year 2017 (October 1, 2016, to September 31, 2017). Records from 135 facilities nationwide supporting both ambulatory and inpatient surgery were included.
A laboratory test occurring within 30 days prior to cataract surgery and within 30 days after clinic evaluation.
Overall national and facility-level rates and associated costs of receiving any of 8 common LVTs in the 30 days prior to cataract surgery. The patient characteristics, procedure type, and facility-level factors associated with receiving at least 1 test, the number of tests received, and receipt of a bundle of 4 tests (complete blood count, basic metabolic profile, chest radiograph, and electrocardiogram).
A total of 69 070 cataract procedures were identified among 50 106 patients (66 282 [96.0%] men; mean [SD] age, 71.7 [8.1] years; 53 837 [77.9%] White, 10 292 [14.9%] Black). Most of the patient population had either overweight (23 292 [33.7%] patients) or obesity (27 799 [40.2%] patients). Approximately 49% of surgical procedures (33 424 procedures) were preceded by 1 or more LVT with an overall LVT cost of $2 597 623. Among patients receiving LVTs, electrocardiography (7434 patients [29.9%]) was the most common, with some patients also receiving more costly tests, including chest radiographs (489 patients [8.2%]) and pulmonary function tests (127 patients [3.4%]). For receipt of any LVT, the intraclass correlation coefficient was 0.61 (P < .001) at the facility level and 0.06 (P < .001) at the surgeon level, indicating the substantial contribution of the facility to amount of tests given.
Despite existing guidelines, use of LVTs prior to cataract surgery is both common and costly within a large, national integrated health care system. Our results suggest that publishing evidence-based guidelines alone-such as the Choosing Wisely campaign-may not sufficiently influence individual physician behavior, and that system-level efforts to directly deimplement LVTs may therefore necessary to effect sustained change.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>33956131</pmid><doi>10.1001/jamanetworkopen.2021.7470</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Anesthesiology Cataract Extraction - adverse effects Cohort Studies Costs Diagnostic Tests, Routine - economics Electrocardiography - economics Eye surgery Female Health Care Costs Humans Low-Value Care Male Medical Overuse - economics Online Only Original Investigation Patients Postoperative Complications - prevention & control Radiography, Thoracic - economics Respiratory Function Tests - economics United States United States Department of Veterans Affairs - economics Veterans Health Services - economics |
| title | Variability and Costs of Low-Value Preoperative Testing for Cataract Surgery Within the Veterans Health Administration |
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