Hospitalists should view a new American College of Physicians (ACP) list of three dozen commonly overused clinical tests that offer lower value as an opportunity to review their use of screening and diagnostic tools, according to one of the list's authors.
Jeff Wiese, MD, SFHM, professor of medicine and residency program director at Tulane University Health Sciences Center in New Orleans, coauthored research published in January in the Annals of Internal Medicine that he says represents clinical situations in which tests have historically been administered but, upon further review, do not reflect "high-value care."
"Nobody is trying to waste money," says Dr. Wiese, a former president of SHM who adds that physicians over time might learn that tests that once offered higher value may no longer do so. "Only by critically reviewing our habits are we able to make the necessary adjustments to ensure we are delivering high-value, cost-conscious care."
ACP convened an ad hoc workgroup of internal-medicine specialists to review lower-value tests; the list that the team came up with includes:
- Repeat screening ultrasonography for abdominal aortic aneurysm following a negative study;
- Screening for prostate cancer in men older than 75 or with a life expectancy of less than 10 years; and
- Performing serologic testing for suspected early Lyme disease.
Dr. Wiese emphasizes that decisions regarding "cost-conscious care" must be interpreted in the context of the specific patient in front of them.
"There is no decision rule that applies to all patients," he says. "The tests addressed in the article are examples of tests that do not routinely offer high value, but this is not to say that there are not specific circumstances when they might be useful."