High-Value Testing Begins With a Few Simple Questions
Authors: Christine Laine
Journal: Annals of Internal Medicine (2012)

Editorials17 January 2012High-Value Testing Begins With a Few Simple QuestionsChristine Laine, MD, MPH, Editor in ChiefChristine Laine, MD, MPH, Editor in ChiefAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-2-201201170-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In light of escalating health care costs and recognition that too large a proportion of care provides little or no benefit to patients, the American College of Physicians (ACP) convened a workgroup of physicians to identify common clinical situations in which the use of tests fails to provide high-value, cost-conscious care. The ACP defines high-value, cost-conscious care as delivery of services that provide benefits commensurate with their cost and that outweigh any associated harm (1, 2). Value is not merely cost. An expensive test that alters care and outcome in a positive way is of greater value than a cheap ...References1. Owens DK, Qaseem A, Chou R, Shekelle P; for the Clinical Guidelines committee of the American College of Physicians. High value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Ann Intern Med. 2011;154:174-80. LinkGoogle Scholar2. American College of Physicians. How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently? [policy paper]. Philadelphia: American Coll Physicians; 2011. Google Scholar3. Qaseem A, Alguire P, Dallas P, Eisenberg 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. LinkGoogle Scholar4. Good Stewardship Working Group. The "top 5" lists in primary care: meeting the responsibility of professionalism. Arch Intern Med. 2011;171:1385-90. CrossrefMedlineGoogle Scholar5. Sox HC, Blatt MA, Higgins MS, Marton KI. Medical Decision-Making. Philadelphia: American Coll Physicians; 2007. Google Scholar6. Orszag PR. Increasing the value of federal spending on health care. Testimony to Committee on the Budget, U.S. House of Representatives, 16 July 2008. Accessed at http://budget.house.gov/hearings/2008/07.16orszag.pdf on 4 December 2011. Google Scholar7. Snyder L; American College of Physicians Ethics. Professionalism, and Human Rights Committee. American College of Physicians Ethics Manual. Sixth Edition. Ann Intern Med. 2012;156:73-104. LinkGoogle Scholar8. Emanuel EJ. Review of the American College of Physicians Ethics Manual, Sixth Edition. Ann Intern Med. 2012;156:56-7. LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Acknowledgment: The author thanks Drs. Cynthia Mulrow, Darren Taichman, and Sankey Williams for their thoughtful review of drafts of this editorial.Disclosures: Dr. Laine is employed by the ACP.Corresponding Author: Annals of Internal Medicine, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106. 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 Zackary D. Berger and Fostering High-Value, Cost-Conscious Care Zackary D. Berger and Metrics Cited ByEthical Considerations in Precision Medicine and Genetic Testing in Internal Medicine Practice: A Position Paper From the American College of PhysiciansLisa Soleymani Lehmann, MD, PhD, Lois Snyder Sulmasy, JD, and Wylie Burke, MD, PhD, for the ACP Ethics, Professionalism and Human Rights Committee*, Isaac O. Opole, MBChB, PhD, Noel N. Deep, MD, George M. Abraham, MD, MPH, Joel Burnett, MD, T. Brian Callister, MD, Jan K. Carney, MD, MPH, Thomas G. Cooney, MD, Kari L. Esbensen, MD, PhD, Joseph J. Fins, MD, Taylor Harp, Amy K. Holbrook, MD, Thomas S. Huddle, MD, PhD, Mark A. Levine, MD, Kenneth M. 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Gellad, MD, MPH, Julie M. Donohue, PhD, Xinhua Zhao, PhD, Maria K. Mor, PhD, Carolyn T. Thorpe, PhD, MPH, Jeremy Smith, MPH, Chester B. Good, MD, MPH, Michael J. Fine, MD, MSc, and Nancy E. Morden, MD, MPHPostoperative Troponin ScreeningThe Declining Radiology Job Market: How Should Radiologists Respond?Physicians' Beliefs About Breast Cancer Surveillance Testing are Consistent With Test OveruseRisk for Hepatocellular Carcinoma in Patients With Alcoholic CirrhosisHans L. Tillman, MD and Steve S. Choi, MDThe Overuse of Diagnostic Imaging and the Choosing Wisely InitiativeVijay M. Rao, MD and David C. Levin, MDFostering High-Value, Cost-Conscious CareZackary D. Berger, MD, PhD, Fostering High-Value, Cost-Conscious CareZackary D. Berger, MD, PhD, for the Good Stewardship Working GroupThe ChosenHealth Care Costs: How Do We Decide Value? When Do We Decide? How Do We Particularize the Decisions? 17 January 2012Volume 156, Issue 2Page: 162-163KeywordsAntibioticsHealth careHealth care providersHealth care qualityHealth surveysHemoglobinMotivationPatientsThoraxTouch ePublished: 17 January 2012 Issue Published: 17 January 2012 CopyrightCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...