Underutilization of upper gastrointestinal endoscopy.

F Froehlich; I Pache; B Burnand; J P Vader; M Fried; J Kosecoff; M Kolodny; R W DuBois; R H Brook; J J Gonvers

doi:10.1053/gast.1997.v112.pm9041229

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PubMed · 9041229

Underutilization of upper gastrointestinal endoscopy.

F Froehlich·I Pache·B Burnand·J P Vader·M Fried·J Kosecoff·M Kolodny·R W DuBois·R H Brook·J J Gonvers

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Abstract

BACKGROUND & AIMS: Efforts to reduce costs in health care may raise concerns about underuse of medical procedures. This study prospectively assessed underuse of upper gastrointestinal endoscopy in a cohort of patients in whom we have recently published data on overuse of endoscopy. METHODS: Underuse was identified by formal necessity criteria for endoscopy, obtained by an explicit panel process. Outpatients were consecutively included in two clinical settings. Setting A consisted of 20 primary care physicians and 7215 patient visits that occurred within 1 month. Setting B consisted of 920 visits that occurred during 3 weeks at an outpatient clinic. RESULTS: During these 8135 visits, 611 patients complained of upper digestive symptoms; 63 of them underwent endoscopy. Underuse was identified in 72 patients (11.8%). The two clinical situations mainly responsible for underuse of endoscopy were uninvestigated peptic symptoms resistant to treatment and dysphagia. At first follow-up, 29 of the patients with initial underuse still fulfilled criteria of necessity (underuse rate, 4.7%). One-year follow-up showed underuse of endoscopy in 5 patients. CONCLUSIONS: This prospective evidence shows that underuse of a medical procedure exists. The estimated overuse and underuse of endoscopy in this cohort were approximately equal (5%). Improving quality of care will require reductions of both overuse and underuse of medical procedures.

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Adolescent Adult Aged Endoscopy, Gastrointestinal Female Health Care Costs Humans Male Middle Aged Prospective Studies Quality of Health Care Journal Article Research Support, Non-U.S. Gov't

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F Froehlich, I Pache, B Burnand, J P Vader, M Fried, J Kosecoff, M Kolodny, R W DuBois, R H Brook, J J Gonvers. 1997. Underutilization of upper gastrointestinal endoscopy.. https://doi.org/10.1053/gast.1997.v112.pm9041229

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