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Sharing data with providers associated with plummeting rates of unnecessary medical tests in Sweden
Date:7/23/2013

es at Ume University, Regional Cancer Center Uppsala University Hospital and Karolinska Institute, as well as at New York's Memorial Sloan-Kettering Cancer Center to examine the records of approximately 100,000 Swedish men diagnosed with prostate cancer from 1998 until 2009. In 2000, the NPCR began a campaign to reduce inappropriate diagnostic imaging among men with low-risk prostate cancer. The campaign involved openly and publicly presenting local statistics on inappropriate imaging at urology meetings, along with reminders about imaging guidelines. Urologists in Sweden could then see imaging rates at their own institution compared to best practices and had an incentive not to be listed as a provider of unnecessary testing. "I think you could consider the tactic a way of "gentle shaming" of the health care providers who did not follow the guidelines" says Dr. Makarov.

The result: During the study period, the percentage of scans deemed inappropriate plummeted from 45% to 3% among patients with low-risk prostate cancer.

"It's recognized that the chance of finding metastases in these patients is very small, and the downsides of the scans include unnecessary costs, a lengthy diagnostic procedure including injection of a radioactive isotope, treatment delays, and, of course, unnecessary worries about advanced disease before the test results are available or after a falsely positive examination," said Dr. Makarov.

However, Dr. Makarov and his colleagues noted that the campaign brought an unwanted side effect: the rate of appropriate scans in patients with high-risk tumors also fell, to 47% from 63%.

"The caveat here is that when guidelines are implemented to limit the inappropriate use of a healthcare resource, the appropriate use of that resource should be simultaneously encouragedotherwise those patients who most need the resource may no longer have access to it," said Dr. Makarov. "But the true lesson from this study is that in
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Contact: Lorinda Klein
lorindaann.klein@nyumc.org
212-404-3533
NYU Langone Medical Center / New York University School of Medicine
Source:Eurekalert

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