Choosing Wisely (R) specialty society recommendation analysis: American College of Obstetricians and Gynecologists (ACOG) : prioritizing opportunities for reducing inappropriate care in New England
- Collection:
- Health Policy and Services Research
- Contributor(s):
- Institute for Clinical and Economic Review, issuing body. New England Comparative Effectiveness Public Advisory Council, issuing body.
- Publication:
- [Boston, MA] : Institute for Clinical and Economic Review, [2014]
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Gynecology -- standards Obstetrics -- standards Unnecessary Procedures -- statistics & numerical data Cost Savings Societies, Medical Women's Health Services Female Humans New England United States
- Genre(s):
- Technical Report
- Abstract:
- As a participant in the Choosing Wisely(R) campaign, ACOG selected five services whose use should be sharply reduced or eliminated. Focusing on each of these tests or procedures, we analyzed current regional patterns of utilization, the feasibility of practice change, and the opportunity for cost savings. We conducted an assessment of the factors driving use of the services and barriers to change and included a summary of existing public and private payer coverage policies. We derived a recommended action priority ranking of each of the ACOG services based on judgments of the best opportunities for successful intervention to improve patient outcomes and lower costs across New England. ACOG's identified "wasteful" services: Service #1: Don't schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age. Service #2: Don't schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable. Service #3: Don't perform routine annual cervical cytology screening (Pap tests) in women 30-65 years of age. Service #4: Don't treat patients who have mild dysplasia of less than two years in duration. Service #5: Don't screen for ovarian cancer in asymptomatic women at average risk. Based on national and regional prevalence and utilization data, the estimated affected population in New England and excess costs of inappropriate practice were calculated on a per case/screen basis. Estimated Population Affected Excess Cost of Inappropriate Practice: Service #1: 11,000-17,000 annual births. Service #1: $2,300-$7,500 per case. Service #2: 35,000-62,000 annual births. Service #2: $400-$900 per case. Service #3: 1.6-2.3 million women. Service #3: $80-$160 per screen. Service #4: 2,500-6,000 women annually. Service #4: $500-$1,100 per case. Service #5: 20,000-130,000 women annually. Service #5: $80-$700 per screening. Through a series of unstructured interviews with 12 regional and national clinical and policy experts, we evaluated factors associated with overuse and practice variation. We engaged stakeholders representing health centers, hospitals, academic institutions and health insurers to understand the most effective methods to reducing inappropriate use as well as current best practices for enacting practice change.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)
- Extent:
- 1 online resource (1 PDF file (48 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101634776 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101634776