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Invited Commentary
Less Is More
June 8, 2020

Testing Cascades—A Call to Move From Descriptive Research to Deimplementation Science

Author Affiliations
  • 1Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 2Division of General Internal Medicine, University of California, San Francisco
  • 3Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
JAMA Intern Med. 2020;180(7):984-985. doi:10.1001/jamainternmed.2020.1588

Over the past decade, attention to overuse of testing has steadily grown, reflected by the addition of low-value care, Choosing Wisely, less is more, and cost-conscious care to the medical vernacular. Despite widespread recognition of this issue, there has been little evidence of large-scale changes in testing practices in the US.1,2 There may be many barriers to reducing overuse, including a fee-for-service payment model that disincentivizes physicians and health systems from reducing use of revenue-generating tests, a belief that more testing is beneficial, and framing of the issue as largely a problem of health care costs.3 Physicians and patients alike may have few incentives to reduce testing solely to reduce health system costs. For patients, who often do not directly incur testing costs, any efforts to reduce testing may be perceived as rationing. Physicians may view patient reassurance and satisfaction as more important than cost containment, and they may profit directly or indirectly from such testing. Successful efforts to deimplement low-value practices will require an alignment of interests and an understanding of the negative consequences of routine testing beyond costs.

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