BACKGROUND/RATIONALE:
Over the course of the past two decades VHA has implemented a coordinated set of performance measurement, incentive, and clinical reminder systems to reduce the underuse of preventive health services. The results have been dramatic increases in the use of these services. However, the intense focus on underuse may have pushed the pendulum too far, resulting in overuse of these interventions among patients who are unlikely to benefit and could be harmed. My work seeks to develop an empirically-based understanding of the processes that lead to overuse in the primary care.

OBJECTIVE(S):
(1) Establish a program of research to develop and validate a conceptual framework that elucidates the effects of organizational, provider and patient factors on overuse of preventive health services. (2) Assess the effect of organizational factors on overuse of colorectal cancer screening.

METHODS:
Projects included: (1) a quantitative analysis of VHA administrative data to quantify inappropriate CRC screening rates and to assess relationships between facility-level performance on the CRC screening PM, features of facility CRC screening computerized clinical reminders and inappropriate CRC screening ; (2) a narrative review of literature examining antecedents of overuse in primary care; (3) qualitative patient interviews to explore how clinical reminders and other aspects of the clinical encounter affect overuse and patient-centered care.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This work will identify processes by which PMs and other system, provider and patient variables influence inappropriate use of CRC screening and other primary care health services. The published framework we developed will provide researchers and practitioners with guidance in designing intereventions to reduce overuse. Findings from this line of research will lead to better methods of measuring care, reduced costs, and more personalized care plans that accommodate each veteran's unique health status and preferences.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Powell AA, Bloomfield HE, Burgess DJ, Wilt TJ, Partin MR. A conceptual framework for understanding and reducing overuse by primary care providers. Medical care research and review : MCRR. 2013 Oct 1; 70(5):451-72. [view]
2. Partin MR, Powell AA, Burgess DJ, Wilt TJ. Bringing an organizational perspective to the optimal number of colorectal cancer screening options debate. Journal of general internal medicine. 2012 Mar 1; 27(3):376-80. [view]
3. Partin MR, Powell AA, Nugent S, Ordin DL. Colorectal cancer diagnosis improvement project evaluation demonstrates the importance of using multiple measures to track progress toward timeliness goals. Journal for healthcare quality : official publication of the National Association for Healthcare Quality. 2013 May 1; 35(3):41-8. [view]
4. Powell AA, Nugent S, Ordin DL, Noorbaloochi S, Partin MR. Evaluation of a VHA collaborative to improve follow-up after a positive colorectal cancer screening test. Medical care. 2011 Oct 1; 49(10):897-903. [view]
5. Partin MR, Powell AA, Bangerter A, Halek K, Burgess JF, Fisher DA, Nelson DB. Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration. Journal of general internal medicine. 2012 Dec 1; 27(12):1618-25. [view]
6. Powell AA, White KM, Partin MR, Halek K, Hysong SJ, Zarling E, Kirsh SR, Bloomfield HE. More than a score: a qualitative study of ancillary benefits of performance measurement. BMJ quality & safety. 2014 Aug 1; 23(8):651-8. [view]
7. Espaldon R, Kirby KA, Fung KZ, Hoffman RM, Powell AA, Freedland SJ, Walter LC. Probability of an abnormal screening prostate-specific antigen result based on age, race, and prostate-specific antigen threshold. Urology. 2014 Mar 1; 83(3):599-605. [view]

Journal Other

1. Partin MR, Powell AA. If less is more, which outcomes should be presented in facilitating prostate cancer screening decision making? [Letter to the Editor]. JAMA internal medicine. 2013 Sep 23; 173(17):1656-7. [view]

Center Products

1. Partin MR, Powell AA, Wilt TJ. The PSA Test for Prostate Cancer Screening: Why some doctors no longer recommend testing. 2013 Jun 1. [view]

Conference Presentations

1. Powell AA, Bloomfield HE, Burgess DJ, Wilt TJ, Taylor BC, Partin MR. A Conceptual Framework for Understanding and Reducing Provider Overuse of Primary Care Services. Poster session presented at: Preventing Overdiagnosis Annual Conference; 2013 Sep 11; Hanover, NH. [view]
2. Partin MR, Powell AA, Taylor BC, Burgess DJ, Wilt TJ. Communicating with Patients About Over Diagnosis: Development of a Pamphlet to Improve Understanding of the Benefits and Harms of Prostate Cancer Screening, and to Address Patient Concerns about Discontinuation. Presented at: Preventing Overdiagnosis Annual Conference; 2013 Sep 11; Hanover, NH. [view]
3. Partin MR, Powell AA, Taylor BC. Communicating with Physicians About Over Diagnosis of Prostate Cancer: The Promise of Narrative Communication Techniques for Addressing Barriers to Change. Poster session presented at: Preventing Overdiagnosis Annual Conference; 2013 Sep 11; Hanover, NH. [view]
4. Powell AA, Bloomfield HE, Burgess DJ, Wilt TJ, Taylor BC, Partin MR. Overuse of Colorectal Cancer Screening in the Veterans Health Administration. Presented at: Preventing Overdiagnosis Annual Conference; 2013 Sep 11; Hanover, NH. [view]

DRA: Health Systems, Cancer, Aging, Older Veterans' Health and Care
DRE: Prevention
Keywords: none
MeSH Terms: none