Annals of Internal MedicineReducing Care Overuse in Older Patients Using Professional Norms and Accountability

Harnessing Behavioral Science to Tackle Overuse in Healthcare

A recent cluster randomized controlled trial investigated the efficacy of clinician decision support tools, augmented by brief case-based education, in reducing medical overuse among older patients within primary care settings. The study aimed to address the critical issue of care overuse, which often leads to unnecessary harm, by incorporating behavioral science principles that highlight potential harms, emphasize social norms, and foster a sense of accountability among clinicians.

Study Design:

• Setting: The study was conducted in 60 primary care practices (internal medicine, family medicine, and geriatrics) within a health system, from September 2020 to February 2022.
• Participants: 371 primary care clinicians and their older adult patients.
• Intervention Group: 187 clinicians received point-of-care clinical decision support tools plus brief case-based education.
• Control Group: 187 clinicians received brief case-based education alone.

Key Findings:

• Reductions in Overuse: The intervention group saw significant decreases in the annual rates of prostate-specific antigen (PSA) testing, unspecified urine testing, and overtreatment of diabetes with hypoglycemic agents.
• Safety Measures: No increase in emergency care for urinary tract infections or hyperglycemia was observed. However, a slight increase in HbA1c levels (>9.0%) was noted among previously overtreated diabetes patients in the intervention group.
• Limitations: The study’s findings are limited by its single health system setting and reliance on electronic health data, which may not accurately capture all instances of overtesting or underdocumentation.

HCN Medical Memo
The study concludes that decision support tools emphasizing potential harms, social norms, and reputational concerns effectively reduce medical overuse, though they may lead to increased instances of uncontrolled diabetes due to reduced overtreatment.

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