Background
Overuse of diagnostic tests contributes substantially to healthcare expenses and potentially exposes patients to unnecessary harm. Our objective was to systematically identify and review studies that assessed the prevalence of overuse of diagnostic tests in healthcare settings to estimate the overall prevalence of low-value diagnostic tests.
Methods
PubMed, Web of Science, and Embase were searched from inception to February 18, 2020 to identify articles published in English that examined the prevalence of diagnostic test overuse using database data. Each of the assessments was classified as a patient indication lens, a patient population lens, or a service lens.
Results
Included in this study were 118 assessments of diagnostic test overuse, drawn from 35 studies.
The majority of included evaluations used a patient indication lens (n = 67, 57%), followed by the service lens (n = 27, 23%) and the patient population lens (n = 24, 20% ). Prevalence estimates of overuse of diagnostic tests ranged from 0.09% to 97.5% (median prevalence of screenings with a patient indication lens: 11.0%, population lens patients: 2.0% and service lens: 30.7%).
Most evaluations (n = 85) reported overuse of diagnostic tests below 25%.
Overuse of diagnostic imaging tests was assessed most frequently (n = 96).
Among the 33 evaluations that reported high levels of overuse (≥25%), preoperative testing (n = 7) and imaging for uncomplicated low back pain (n = 6) were most frequently examined.
For evaluations of similar diagnostic tests, significant variation in the prevalence of overuse was observed.
Differences in the definitions of low-value tests used, their operationalization, and assessment methods likely contributed to this observed variation.
Conclusion
|
