title: Overuse of health care services in the United States: an understudied problem.
abstract: BACKGROUND
  Overuse, the provision of health care services for which harms outweigh benefits, represents poor quality and contributes to high costs. A better understanding of overuse in US health care could inform efforts to reduce inappropriate care. We performed an extensive search for studies of overuse of therapeutic procedures, diagnostic tests, and medications in the United States and describe the state of the literature.
  
  
  METHODS
  We searched MEDLINE (1978-2009) for studies measuring US rates of overuse of procedures, tests, and medications, augmented by author tracking, reference tracking, and expert consultation. Four reviewers screened titles; 2 reviewers screened abstracts and full articles and extracted data including overuse rate, type of service, clinical area, and publication year.
  
  
  RESULTS
  We identified 172 articles measuring overuse: 53 concerned therapeutic procedures; 38, diagnostic tests; and 81, medications. Eighteen unique therapeutic procedures and 24 diagnostic services were evaluated, including 10 preventive diagnostic services. The most commonly studied services were antibiotics for upper respiratory tract infections (59 studies), coronary angiography (17 studies), carotid endarterectomy (13 studies), and coronary artery bypass grafting (10 studies). Overuse of carotid endarterectomy and antibiotics for upper respiratory tract infections declined over time.
  
  
  CONCLUSIONS
  The robust evidence about overuse in the United States is limited to a few services. Reducing inappropriate care in the US health care system likely requires a more substantial investment in overuse research.
authors.affiliation: Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. deborah.korenstein@mssm.edu
authors.forename: Deborah
authors.initials: D
authors.lastname: Korenstein
authors.forename: Raphael
authors.initials: R
authors.lastname: Falk
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Howell
authors.forename: Tara
authors.initials: T
authors.lastname: Bishop
authors.forename: Salomeh
authors.initials: S
authors.lastname: Keyhani
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004363:Drug Utilization; D016894:Endarterectomy, Carotid / Q000706:statistics & numerical data; D004724:Endoscopy / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006300:Health Services Misuse; D006302:Health Services Research; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents