Overuse of 3 Common Tests in the Elderly: Primary Care Physician (PCP) Variation, Associated Physician Characteristics, and Correlation of Overuse of Tests Within Physicians

Overuse of tests in the elderly is a nationwide problem that leads to patient harm. Some of the most commonly ordered tests are overused even though specific guidelines have been published and appropriately disseminated. Previous work has evaluated national, regional, state, levels of overuse but little research has been done examining this problem at the physician level. This is important as physicians are the ones who are ordering the tests. While other levels may affect overtesting, physician factors, such as age, level of training, and personal beliefs, have been associated with overtesting. Determining which physician characteristics are associated with overtesting can help identify physicians with overtesting behaviors. These physicians can then be offered interventions to decrease this behavior. This retrospective study used cohorts from 100% Texas Medicare data to address the following three aims: 1) to determine the degree of between-physician variation in the overuse of screening PSA, screening mammography, and acute low back pain imaging tests, 2) to define the physician characteristics associated with overuse of these tests, and 3) to evaluate the correlation among these three tests at the PCP-level. The cohorts were analyzed using multilevel multivariate logistic regression and Pearson’s correlation. The Intraclass Correlation Coefficient (ICC) score is a marker of how much of the total variation is attributable to certain characteristics. In this study the ICC scores were 0.27 for PSA screening, 0.15 for mammography screening, and 0.25 for acute low back pain. Factors associated with overtesting were Family Medicine specialty and not having U.S. training. There was a weak correlation between overuse of the two cancer screening tests and a very weak correlation between overuse between PSA screening and the use of x-rays for acute low back pain and between Mammography screening and the use of x-rays for acute low back pain.