Table 2. Low-Value Care Use.
| Service | Use per 1000 individuals (95% CI)a | ||||
|---|---|---|---|---|---|
| 2014 | 2015 | 2016 | 2017 | 2018 | |
| Total | 677.8 (676.2-679.5) | 690.6 (689.0-692.1) | 662.9 (661.3-664.4) | 657.8 (656.2-659.3) | 632.7 (632.6-632.8) |
| Prescription drug | 321.3 (319.7-322.9) | 362.0 (360.4-363.5) | 364.5 (363-366.0) | 369.4 (367.9-370.9) | 350.4 (350.3-350.4) |
| Opioid for acute back pain | 154.4 (153.6-155.2) | 182.4 (181.5-183.2) | 187.9 (187-188.7) | 187.3 (186.4-188 .l ) | 182.1 (182.1-182.1) |
| Oral antibiotic for acute upper respiratory or external ear infections | 75.0 (74.9-75.l ) | 86.7 (86.5-86.8) | 84.5 (84.4-84.6) | 91.3 (91.2-91.4) | 82.0 (82.0-82.0) |
| Concurrent use of ≥2 antipsychotic medications | 32.6 (31.2-33.9) | 31.1 (29.8-32.4) | 29.6 (28.3-30.8) | 29.3 (28.1-30.5) | 28.2 (28.1-28.2) |
| Antidepressant monotherapy in bipolar disorder | 0.9.0 (0.9-0.9) | 1.0 (0.9-l.0) | 0.9 (0.9-0.9) | 0.9 (0.9-l.0) | 1.0 (0.9-l.0) |
| NSAID in patient with hypertension, heart failure, or CKD | 58.4 (58.2-58.6) | 60. 8 (60.6-60.9) | 61.5 (61.4-61.7) | 60.3 (60.2-60.5) | 56.9 (56.9-56.9) |
| Antibiotic for adenoviral conjunctivitis without secondary infection or other conditions | 0.1 (0.1-0.l ) | 0.1 (0.1-0.1) | 0.2 (0.2-0.2) | 0.2 (0.2-0.2) | 0.2 (0.2-0.2) |
| Diagnostic test | 12.6 (12.5-12.6) | 12.5 (12.5-12.6) | 13.7 (13.7-13.7) | 13.7 (13.7-13.8) | 13.5 (13.4-13.6) |
| Brain imaging for simple syncope with normal neurological exam | 0.8 (0.8-0.8) | 0.8 (0.8-0.8) | 0.9 (0.9-0.9) | 0.9 (0.9-0.9) | 0.9 (0.9-0.9) |
| Imaging for uncomplicated headache without neurological symptoms | 2.4 (2.3-2.4) | 2.2 (2.2-2.2) | 2.0 (2.0-2.0) | 2.0 (2.0-2.0) | 2.0 (2.0-2.0) |
| Imaging for acute low back pain without red flag signs | 1.6 (1.6-l.6) | 1.6 (1.6-1.6) | 2.1 (2.1-2.l) | 2.0 (2.0-2.0) | 2.0 (2.0-2.0) |
| Immunoglobulin G (or immunoglobulin E test in the evaluation of allergy | 0.5 (0.5-0.5) | 0.5 (0.5-0.5) | 0.7 (0.7-0.7) | 0.8 (0.8-0.8) | 0.8 (0.8-0.9) |
| Routine diagnostic test for chronic urticaria | 0.1 (0.1-0.l) | 0.1 (0.1-0.l) | 0.1 (0.1-0.l) | 0.1 (0.1-0.l) | 0.1 (0.1-0.l) |
| Electroencephalogram for headache | 0.5 (0.5-0.5) | 0.5 (0.5-0.5) | 0.6 (0.6-0.6) | 0.6 (0.6-0.6) | 0.6 (0.6-0.6) |
| Carotid duplex ultrasound for simple syncope with normal neurological examination | 2.8 (2.8-2.8) | 2.9 (2.8-2.9) | 3.5 (3.5-3.S) | 3.4 (3.4-3.4) | 3.2 (3.2-3.2) |
| CT scan of head or brain for sudden-onset hearing loss | 0.6 (0.6-0.6) | 0.7 (0.6-0.7) | 0.6 (0.6-0.6) | 0.7 (0.7-0.7) | 0.7 (0.7-0.7) |
| Imaging for uncomplicated acute rhinosinusitis | 1.7 (1.7-1.7) | 1.7 (1.7-l.7) | 1.7 (1.7-1.7) | 1.7 (1.7-l.7) | 1.6 (1.6-1.6) |
| Coronary artery calcium scoring for known CAD | 0.1 (0.1-0.l ) | 0.1 (0.1-0.l ) | 0.2 (0.1-0.2) | 0.2 (0.2-0.2) | 0.2 (0.2-0.2) |
| CT scan for emergency department evaluation of dizziness | 1.3 (1.3-1.3) | 1.2 (1.2-1.2) | 1.2 (1.2-1.2) | 1.2 (1.2-l.2) | 1.3 (1.3-1.3) |
| Bleeding time test | 0.3 (0.3-0.3) | 0.2 (0.2-0.2) | 0.1 (0.1-0.l) | 0.1 (0.1-0.l) | 0.1 (0-0.l) |
| Preventive screen | 118.0 (117.8-118 .l ) | 107.2 (107.0-107.3) | 98.6 (98.5-98.7) | 94.l (94.0-94.2) | 91.2 (91.2-91.2) |
| Cervical cancer screen in woman not at high risk with adequate prior screening | 24.0 (24-24.l) | 21.8 (21.7-21.8) | 19.8 (19.8-19.8) | 17.9 (17.9-18) | 16 .5 (16.5-16.5) |
| Annual ECG or cardiac screen in patient without symptoms or risk factors | 25.5 (25.3-25.6) | 21.4 (21.2-21.5) | 13.6 (13.5-13.7) | 16.9 (16.8-17) | 19 .9 (19.9-19.9) |
| DEXA screen for osteoporosis in woman aged <65 y or man aged <70 y | 0.1 (0.1-0.l) | 0.1 (0-0.l) | 0.1 (0-0.1) | 0 (0-0) | 0 (0-0) |
| Unnecessary colorectal cancer screening in adult aged 50-75 y | 35.2 (35.2-35.3) | 33.2 (33.1-33.2) | 32.0 (31.9-32) | 31.6 (31.6-31.7) | 30.4 (30.4-30.4) |
| Screen for vitamin D deficiency | 26.7 (26.6-26.7) | 24.4 (24.3-24.4) | 26.4 (26.3-26.4) | 21.5 (21.5-21.5) | 18.6 (18.6-18.6) |
| Cardiac stress test or advanced imaging for patient without symptoms or risk factors | 6.5 (6.5-6.5) | 6.5 (6.4-6.5) | 6.8 (6.8-6.8) | 6.1 (6.1-6.l) | 5.8 (5.8-5.8) |
| Preoperative test | 223.6 (223.2-223.9) | 206.3 (206.l-206.6) | 183.4 (183.2-183.7) | 178 (177.7-178.2) | 175.0 (175.0-175.0) |
| Preoperative laboratory study in patient without significant systemic illness before elective low-risk surgery | 213.8 (213.4-214.2) | 196.7 (196.4-197) | 174.0 (173.7-174.2) | 168.7 (168.4-168.9) | 166.2 (166.2-166.2) |
| Preoperative ECG, chest radiograph, or pulmonary function test in patient without significant systemic illness before low-risk surgery | 9.5 (9.5-9.5) | 9.4 (9.4-9.4) | 9.2 (9.2-9.3) | 9.0 (9.0-9.0) | 8. 6 (8.6-8.6) |
| Preoperative echocardiogram or stress test before low-risk or intermediate-risk noncardiac surgery | 0.2 (0.1-0.2) | 0.1 (0.1-0.l) | 0.1 (0.1-0.l) | 0.1 (0.1-0.l ) | 0.1 (0.1-0.l) |
| Routine pulmonary function test before cardiac surgery | 0.1 (0.1-0.l ) | 0.1 (0.1-0.1) | 0.1 (0.1-0.1) | 0.1 (0.1-0.1) | 0.1 (0.1-0.1) |
| Invasive procedure | 2.5 (2.4-2.5) | 2.5 (2.5-2.5) | 2.6 (2.6-2.6) | 2.6 (2.6-2.6) | 2.7 (2.6-2.7) |
| Renal artery revascularization | 0.2 (0.2-0.2) | 0.2 (0.2-0.2) | 0.3 (0.3-0.3) | 0.2 (0.2-0.2) | 0.3 (0.2-0.3) |
| Arthroscopic lavage and debridement for knee osteoarthritis | 0.1 (0.1-0.l ) | 0.1 (0.1-0.1) | 0.1 (0.l-0.l ) | 0.1 (0.l-0.l) | 0.1 (0.1-0.l ) |
| Peripherally inserted central catheter in patient with stage 3-5 CKD | 0.7 (0.7-0.7) | 0.8 (0.8-0.8) | 0.9 (0.9-0.9) | 0.9 (0.9-0.9) | 0.9 (0.9-0.9) |
| Coronary angiogram in patient without symptoms or risk factors | 1.4 (1.4-1.4) | 1.4 (1.4-1.4) | 1.3 (1.3-1.3) | 1.4 (1.4-1.4) | 1.4 (1.4-1.4) |
Abbreviations: CAD, coronary artery disease; CKD, chronic kidney disease; CT, computed tomography; DEXA, dual energy x-ray absorptiometry; ECG, electrocardiogram; NSAID, nonsteroidal anti-inflammatory drug.
a
For detailed measure specifications, please see eTable 1 in the Supplement.