Characterizing the relationship between diagnostic intensity and quality of care
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Michael I. Ellenbogen
,
Laura Prichett
Abstract
Objectives
The relationship between diagnostic intensity and quality of care has not been well-characterized at the hospital level. We performed an exploratory analysis to better delineate this relationship using a hospital-level diagnostic overuse index and accepted hospital quality metrics (readmissions and mortality).
Methods
We previously developed and published a hospital-level diagnostic overuse index. A hospital’s overuse index value (which ranges from 0 to 0.986, with larger numbers indicating more overuse) was our predictor variable of interest. The outcome variables were excess readmission ratios and mortality rates for common medical conditions, which CMS publicly reports. The model controlled for Elixhauser comorbidity score, hospital bed size, hospital teaching status, and random effects that vary by state.
Results
We did not find a statistically significant relationship between our overuse index and the quality measures we evaluated.
Conclusions
The lack of a significant relationship between diagnostic intensity and quality, at least as measured by our overuse index and the tested quality metrics, suggests that well-targeted efforts to reduce diagnostic overuse in hospitals may not adversely impact quality of care.
Funding source: Johns Hopkins Hospitalist Scholars Fund
Funding source: Agency for Healthcare Research and Quality 10.13039/100000133
Award Identifier / Grant number: R01 #HS 27614
Funding source: Armstrong Institute Center for Diagnostic Excellence
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Research funding: Drs. Ellenbogen and Brotman are supported by the Johns Hopkins Hospitalist Scholars Fund (internal funding). Dr. Newman-Toker’s effort was supported by a grant from the Agency for Healthcare Research and Quality (R01 #HS 27614) and the Armstrong Institute Center for Diagnostic Excellence.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: Not applicable.
References
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© 2021 Walter de Gruyter GmbH, Berlin/Boston
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- Frontmatter
- Editorial
- From Camille Nούς to Apollonian and the Dionysian scientists
- Review
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- Mini Reviews
- Updated picture of SARS-CoV-2 variants and mutations
- Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury
- Opinion Papers
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- Original Articles
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