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Benchmarking Overuse of Medical Interventions for Bronchiolitis

Shawn Ralston, MD1; Kavita Parikh, MD2; David Goodman, MD, MS3,4
[+] Author Affiliations
1Section of Pediatric Hospital Medicine, Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
2Children’s National Medical Center, Washington, DC
3Department of Pediatrics, Children’s Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
4Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
JAMA Pediatr. 2015;169(9):805-806. doi:10.1001/jamapediatrics.2015.1372.
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This Viewpoint discusses the relative paucity of attention paid to overuse of medical interventions with regard to bronchiolitis.

While quality improvement and patient safety are hot topics in medicine, there are still significant knowledge and improvement gaps. Quality-improvement efforts may be categorized by whether they relate to underuse, misuse, or overuse of medical interventions. Much work has been done on the underuse of effective care (immunizations) and the misuse of care (medication errors), whereas there appears to be a relative paucity of attention paid to overuse, with fewer studies and fewer quality metrics.1 Nevertheless, overtreatment represents one of the major quality problems in medicine in the United States, with midrange estimates positing that it makes up 20% of the approximately $900 billion in annual waste in our system.2 Furthermore, overtreatment should be of particular concern to physicians because we are directly responsible for the problem; physicians are not primarily responsible for administrative complexity, pricing failures, or most of the fraud in the system, but we undeniably order the tests and treatments that constitute overuse.

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