Accountability for underuse and overuse of cancer screening
Menée aux Etats-Unis à partir des données 2007-2014 de la base Medicare (17 252 345 personnes-années), cette étude évalue, du point de vue de la pertinence des examens de dépistage du cancer colorectal, du cancer du sein ou de la prostate réalisés chez les personnes âgées de 65 ans ou plus, l'intérêt du "Medicare Shared Savings Program ACO", un programme destiné à optimiser les soins pour réduire les dépenses de santé
In this issue of JAMA Internal Medicine, Resnick and colleagues1 test the hypothesis that Medicare Accountable Care Organizations (ACOs) are associated with changes in cancer screening among beneficiaries. Accountable Care Organizations are intended to provide incentives for care coordination and promote high-quality care. In addition, measures for underuse of breast and colorectal cancer screening are routinely used to evaluate ACO quality of care. While no measures specifically address overuse of cancer screening, ACOs are responsible for downstream negative effects from overscreening—harms from the test, overdiagnosis, and overtreatment. Therefore, one would expect ACOs to increase cancer screening when appropriate and reduce cancer screening when inappropriate, reducing both underuse and overuse.
JAMA Internal Medicine , commentaire, 2017