An index for measuring overuse of health care resources with medicare claims

Jodi Segal, Najlla Nassery, Hsien-Yen Chang, Eva Chang, Kitty Chan, John F P Bridges

Research output: Contribution to journalArticle

Abstract

Background: Overuse can be defined as use of a service when the risk of harm exceeds its likely benefit. Yet, there has been little work with composite measures of overuse. Objective: Our goal was to create a composite measure of overuse with claims data. Design: Observational study using 5% of Medicare claims from 2008. Setting: All inpatient and outpatient settings of care, excluding nursing homes. Participants: Older Americans receiving health care services in hospitals or outpatient settings. Measures: We applied algorithms to identify specific cases of overuse across 20 previously identified procedures and used multilevel modeling techniques to examine variation in overuse across all procedures. Included in the model were patient-level factors and both procedure and regional fixed effects for the 306 hospital referral regions (HRR). These estimated regional fixed effects, representing the systematic, region variation in overuse across all measures, was then normalized compared with the overall average to generate a Z score for each HRR. The resulting "Overuse Index" was then compared with total costs, 30-day postdischarge mortality, and total mortality at the HRR level, graphically, and associations were tested using Spearman ρ. Results: The Overuse Index varied markedly across regions, but 23 were higher than the average (P

Original languageEnglish (US)
Pages (from-to)230-236
Number of pages7
JournalMedical Care
Volume53
Issue number3
DOIs
StatePublished - Feb 28 2015

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Health Resources
Medicare
Referral and Consultation
Delivery of Health Care
Mortality
Ambulatory Care
Nursing Homes
Health Services
Observational Studies
Inpatients
Outpatients
Costs and Cost Analysis

Keywords

  • health care utilization
  • medicare
  • overuse
  • regional variation

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Medicine(all)

Cite this

An index for measuring overuse of health care resources with medicare claims. / Segal, Jodi; Nassery, Najlla; Chang, Hsien-Yen; Chang, Eva; Chan, Kitty; Bridges, John F P.

In: Medical Care, Vol. 53, No. 3, 28.02.2015, p. 230-236.

Research output: Contribution to journalArticle

Segal, Jodi ; Nassery, Najlla ; Chang, Hsien-Yen ; Chang, Eva ; Chan, Kitty ; Bridges, John F P. / An index for measuring overuse of health care resources with medicare claims. In: Medical Care. 2015 ; Vol. 53, No. 3. pp. 230-236.
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