Overuse Stewardship: An Ongoing Problem That Must Be Tackled.

Abstract

In this issue of Pediatrics , Tchou et al1 perform a retrospective analysis of administrative data and find that children’s hospitals differ in their use of electrolyte testing for common inpatient conditions such as constipation and gastroenteritis. This should not come as a surprise. It is well established that children’s hospitals differ in management and outcomes for many common conditions.2 However, this study demonstrates a bigger problem. Hospitals have similar testing patterns across conditions, even after adjusting for patient factors. In other words, some hospitals test at either high or low rates regardless of the condition. As the authors state, there appears to be “a culture of testing.” The variability reported by Tchou et al1 is likely a function of both underuse and overuse. Whereas underuse is problematic, overuse of medical tests is a public health problem. It is an expensive and ethical problem affecting the health and well-being of entire hospitals and communities.3 The Congressional Budget Office estimates that doctors spend up to 5% of the national gross domestic product on … Address correspondence to Joel S. Tieder, MD, MPH, Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine, 4800 Sand Point Way, T-1201, Seattle, WA 98105. E-mail: joel.tieder{at}seattlechildrens.org