By Stephanie Murg, Managing Director, G2 Intelligence
Efforts to discourage the use of high-cost, low-value preoperative tests—those ordered “in the absence of a specific clinical indication or purpose”—have had little effect on utilization, according to a national study published earlier this month in the online edition of JAMA Internal Medicine. Researchers at New York University’s Langone Medical Center found that despite the 2002 guidance on this type of testing, no significant changes in ordering patterns have occurred in the ensuing years.
“Our findings suggest that professional guidance aimed at improving quality and reducing waste has had little effect on physician or hospital practice,” says Alana E. Sigmund, M.D., the lead author and an assistant professor in the Department of Medicine at NYU Langone.
Over the 14-year-period studied (1997-2010), the researchers saw no significant decline in preoperative use of plain radiography, hematocrit, urinalysis, and cardiac stress testing. The 2002 recommendations, guidance released concurrently by the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists, was associated only with a reduced incidence of routine electrocardiogram testing.
The authors attribute their findings to several factors. “Evidence suggests physicians are more likely to follow guidelines that add rather than eliminate a test or procedure,” says Joseph Ladapo, M.D., Ph.D., an assistant professor in the Department of Population Health at NYU Langone and the study’s senior author. “In addition, physicians may not have been aware of the recommendations or may not have believed they applied to their patients. They also may have been unduly influenced by reimbursement practices.”