Mafi and colleagues have used a large primary care database to compare use of guideline-discordant low-value health care services. On multivariate analysis there is no winner – they use this service on an equivalent proportion of index conditions (e.g. use of x-ray in backache). Risk-adjustment and using the indication rather than the patient to create denominators reduces (but of course cannot eliminate) bias. Note, however, that making the same proportion of guideline-discordant services does not mean that care was of equivalent quality, since the services may be better targeted in one group than the other. The results support greater use of less expensive health personnel for the bulk of primary care, so that medical expertise can be better used.
— Richard Lilford, CLAHRC WM Director
- Mafi JN, Wee CC, Davis RB, Landon BE. Comparing Use of Low-Value Health Care Services Among U.S. Advanced Practice Clinicians and Physicians. Ann Intern Med. 2016; 165(4): 237-44.