Temporal trends and regional variation in the utilization of low-value breast cancer care: has the Choosing Wisely campaign made a difference? Breast Cancer Res Treat 2019 Jul;176(1):205-215
Date
04/12/2019Pubmed ID
30972612Pubmed Central ID
PMC6687306DOI
10.1007/s10549-019-05213-zScopus ID
2-s2.0-85066813034 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
PURPOSE: Since 2012, about 80 specialty societies have released Choosing Wisely (CW) recommendations aimed at reducing the use of low-value, unproven, or ineffective medical services. The extent to which these recommendations have influenced the behavior of physicians and patients remains largely unknown.
METHODS: Using MarketScan Commercial Claims and Medicare Supplemental and Coordination of Benefits databases, we identified annual cohorts of women with incident, early-stage breast cancer and estimated the prevalence of four initial treatment and six surveillance metrics deemed as low-value breast cancer care by CW. Multivariable logistic regressions were subsequently used to estimate temporal trends and regional variation in the use of these metrics, with a special focus on the year of CW's publication.
RESULTS: There were 122,341 women identified as undergoing treatment for incident breast cancer between 2010 and 2014. Two of the four low-value initial treatment metrics and four of the six low-value surveillance metrics declined significantly over time. The temporal trend of declining use, however, preceded the release of CW's guidelines. Declines ranged from 11.0% for follow-up mammography to 40.6% for receipt of surgical biopsy without an attempted needle biopsy. There were marked regional differences in use of low-value breast cancer care for all metrics, much of which persisted after publication of CW.
CONCLUSIONS: With two notable exceptions, use of low-value breast cancer care has declined steadily since 2010. The declines, however, were not accelerated by the publication of CW recommendations.
Author List
Neuner JM, Nattinger AB, Yen T, McGinley E, Nattinger M, Pezzin LEAuthors
Emily L. McGinley Biostatistician III in the Center for Advancing Population Science department at Medical College of WisconsinAnn B. Nattinger MD, MPH Associate Provost, Professor in the Medicine department at Medical College of Wisconsin
Joan Neuner MD, MPH Professor in the Medicine department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Breast Neoplasms
Delivery of Health Care
Female
Humans
Middle Aged
Patient Acceptance of Health Care
Patient Care
Public Health Surveillance
Spatio-Temporal Analysis
United States
