Background: Healthcare in the U.S. is increasingly delivered by large health systems that include one or more hospitals and associated outpatient practices. It is unclear what role health systems play in driving or preventing overutilization of healthcare services in the U.S. We sought to learn what characteristics allow certain health systems to avoid low-value care [...]

Background: Previous work suggests that hospitals’ teaching status is correlated with readmission rates, cost of care, and mortality. This research has focused on conditions closely tracked by the Centers for Medicare and Medicaid Services (CMS). The extent to which hospitals’ teaching status impacts care processes for syncope has not been extensively studied. Methods: We merged [...]

Background: Low-value care in the form of overuse of inpatient diagnostic testing is an important driver of high healthcare costs. Financial incentives are known to impact physician behavior and may be a driver of inpatient diagnostic overuse. However, the association between hospital payer mix (which likely impacts the financial incentives for ordering diagnostic tests) and [...]

Background: Hip fracture is a common reason for urgent inpatient surgery. In the last few years, several professional societies have identified preoperative echocardiography and stress testing for non-cardiac surgeries as low-value diagnostics. Delaying hip fracture surgery beyond 48 hours leads to worse outcomes. We sought to describe the prevalence of preoperative cardiac testing for inpatient [...]

Background: Guidelines for inpatient diabetes management recommend insulin therapy for persistent hyperglycemia >180 mg/dL with a target glucose range of 140 – 180 mg/dL.1,2 Although guidelines recommend glucose monitoring for insulin administration, there is no standard monitoring approach for patients without evidence of persistent hyperglycemia. As such, hospitalized patients are frequently started on 3 – [...]

Background: Urine culture testing should primarily be reserved for patients with clinical symptoms or other limited indications. Unfortunately, many admitted patients undergo unnecessary urine culture testing, leading to overdiagnosis and overtreatment of asymptomatic bacteriuria (ASB). Unnecessary antibiotic treatment for ASB does not improve outcomes and exposes patients to side effects. The negative implications may include [...]

Background: Prior studies of routine blood culture (BC) testing in uncomplicated community acquired pneumonia (CAP), skin and soft tissue infections (SSTI), and urinary tract infections (UTI) have demonstrated low utility given similar rates of pathogen versus contaminant detection and little effect on clinical management. Understanding patterns and outcomes of BC testing can identify opportunities to [...]

Background: Inpatient diabetes guidelines recommend insulin therapy for persistent hyperglycemia, defined as ≥ 2 glucose values ≥ 180 mg/dL, with a target glucose range of 140–180 mg/dL (1). However, there is no guidance on point of care glucose (POC-G) testing frequency for patients receiving routine four-times-daily tests without meeting persistent hyperglycemia criteria. Our prior study [...]