Fostering High-Value, Cost-Conscious Care
Authors: James R. Johnson
Journal: Annals of Internal Medicine (2012)

Letters19 June 2012Fostering High-Value, Cost-Conscious CareJames R. Johnson, MDJames R. Johnson, MDFrom Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-12-201206190-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The clinical situations identified by Qaseem and coworkers (1), in which a test does not reflect high-value care, omitted what may be the most frequently misused infectious disease screening tests of all: the humble urinalysis and urine culture. Such testing is almost always inappropriate when performed in patients without clinical manifestations of overt urinary tract infection, especially if positive results are interpreted as indicating the presence of infection in need of treatment (2, 3). Although the cost per test is low, the enormous number of tests ordered results in substantial aggregate costs. More important, unnecessary and potentially ...References1. Qaseem A, Alguire P, Dallas P, Feinberg LE, Fitzgerald FT, Horwitch C, et al. Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care. Ann Intern Med. 2012;156:147-9. [PMID: 22250146] LinkGoogle Scholar2. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; Infectious Diseases Society of America. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40:643-54. [PMID: 15714408] CrossrefMedlineGoogle Scholar3. Hooton TM, Bradley SF, Cardenas DD, Colgan R, Geerlings SE, Rice JC, et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625-63. [PMID: 20175247] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417.Disclosures: Dr. Johnson has received research support from Merck, Rochester Medical Group, and Syntiron. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAppropriate Use of Screening and Diagnostic Tests to Foster High-Value, Cost-Conscious Care Amir Qaseem , Patrick Alguire , Paul Dallas , Lawrence E. Feinberg , Faith T. Fitzgerald , Carrie Horwitch , Linda Humphrey , Richard LeBlond , Darilyn Moyer , Jeffrey G. Wiese , and Steven Weinberger Fostering High-Value, Cost-Conscious Care Ronald N. Levy Fostering High-Value, Cost-Conscious Care Amir Qaseem , Patrick Alguire , and Steven Weinberger Fostering High-Value, Cost-Conscious Care Frank J. Rybicki , Michael A. Bettmann , Paul A. Larson , and Harvey L. Neiman Fostering High-Value, Cost-Conscious Care Zackary D. Berger and Fostering High-Value, Cost-Conscious Care Zackary D. Berger and Metrics 19 June 2012Volume 156, Issue 12Page: 902-903KeywordsAntimicrobialsConflicts of interestElderlyInfectious diseasesUrinary tract infectionsUrine ePublished: 19 June 2012 Issue Published: 19 June 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...