Intended for healthcare professionals


Setting a research agenda for medical overuse

BMJ 2015; 351 doi: (Published 25 August 2015) Cite this as: BMJ 2015;351:h4534
  1. Daniel J Morgan, associate professor1,
  2. Shannon Brownlee, writer2,
  3. Aaron L Leppin, postdoctoral research fellow3,
  4. Nancy Kressin, professor4,
  5. Sanket S Dhruva, research fellow5,
  6. Les Levin, professor6,
  7. Bruce E Landon, professor7,
  8. Mark A Zezza, vice president8,
  9. Harald Schmidt, assistant professor9,
  10. Vikas Saini, president10,
  11. Adam G Elshaug, Associate Professor and HCFRF Principal Research Fellow and, Senior Fellow1112
  1. 1Epidemiology, and Public Health, Veterans Affairs Maryland Healthcare System, University of Maryland School of Medicine, 685 W Baltimore St, Baltimore, MD 21201, USA
  2. 2Lown Institute, Dartmouth School of Medicine, Boston, MA, USA
  3. 3Knowledge and Evaluation Research Unit, Mayo Clinic, MN, USA
  4. 4Boston VA and Boston University, Boston, MA, USA
  5. 5Yale University and New Haven VA, New Haven, CT, USA
  6. 6University of Toronto, Toronto, Ontario, Canada
  7. 7Department of Health Care Policy, Beth Israel Deaconess Medical Center, Boston, MA, USA
  8. 8Lewin Group’s Federal Health And Human Services Practice, Washington, DC, USA
  9. 9Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
  10. 10Lown Institute, Harvard Medical School, Brookline, MA, USA
  11. 11Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Australia
  12. 12Lown Institute, Brookline, MA, USA
  1. Correspondence to: D Morgan
  • Accepted 30 July 2015

Although overuse in medicine is gaining increased attention, many questions remain unanswered. Dan Morgan and colleagues propose an agenda for coordinated research to improve our understanding of the problem

Overuse of medical services is common.1 2 3 4 5 In the United States, overuse represents as much as 30% of provided services5 6 7 8 9 and has been associated with worse outcomes and death.6 10 The problem has existed for decades,1 7 11 12 but despite heightened recognition in recent years13 14 15 16 17 18 many gaps remain in our basic understanding of its scope, drivers, and potential for harming patients physically, mentally, and financially. Recent efforts on overuse include a joint statement by the American Board of Internal Medicine and Academy Health calling for improved definitions of medical overuse,19 and the Robert Wood Johnson Foundation recommended changes in state policy to reduce overuse.20

Although the Agency for Healthcare Research and Quality (AHRQ) sponsored a report on medical overuse in 2009, this report did not delineate a framework for research.21 Research into overuse remains poorly coordinated and terms such as overuse, overdiagnosis, and low value care are all used to describe various interpretations of the concept. Without a common language or conceptual framework to connect research efforts and objectives, understanding of overuse will remain fragmented and limit our ability to make healthcare safer, less expensive, and more patient centered. Calls have been made for a research agenda.22 23 This article provides a conceptual framework organizing the current research on overuse and formulating a research agenda. It reflects the consensus opinions of a working group of clinicians and researchers convened by the Lown Institute in December 2013.

What do we know about overuse?


The Institute of Medicine and others have defined overuse as “care in the …

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