{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T03:31:06Z","timestamp":1790652666632,"version":"4.1.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2022,8,1]]},"abstract":"<jats:sec id=\"ab-ioi220035-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Within the Veterans Health Administration (VA), the use and cost of low-value services delivered by VA facilities or increasingly by VA Community Care (VACC) programs have not been comprehensively quantified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi220035-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify veterans\u2019 overall use and cost of low-value services, including VA-delivered care and VA-purchased community care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi220035-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cross-sectional study assessed a national population of VA-enrolled veterans. Data on enrollment, sociodemographic characteristics, comorbidities, and health care services delivered by VA facilities or paid for by the VA through VACC programs were compiled for fiscal year 2018 from the VA Corporate Data Warehouse. Data analysis was conducted from April 2020 to January 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi220035-7\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>VA administrative data were applied using an established low-value service metric to quantify the use of 29 potentially low-value tests and procedures delivered in VA facilities and by VACC programs across 6 domains: cancer screening, diagnostic and preventive testing, preoperative testing, imaging, cardiovascular testing and procedures, and other procedures. Sensitive and specific criteria were used to determine the low-value service counts per 100 veterans overall, by domain, and by individual service; count and percentage of each low-value service delivered by each setting; and estimated cost of each service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi220035-8\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 5.2 million enrolled veterans, the mean (SD) age was 62.5 (16.0) years, 91.7% were male, 68.0% were non-Hispanic White, and 32.3% received any service through VACC. By specific criteria, 19.6 low-value services per 100 veterans were delivered in VA facilities or by VACC programs, involving 13.6% of veterans at a total cost of $205.8 million. Overall, the most frequently delivered low-value service was prostate-specific antigen testing for men aged 75 years or older (5.9 per 100 veterans); this was also the service with the greatest proportion delivered by VA facilities (98.9%). The costliest low-value services were spinal injections for low back pain ($43.9 million; 21.4% of low-value care spending) and percutaneous coronary intervention for stable coronary disease ($36.8 million; 17.9% of spending).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi220035-9\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>This cross-sectional study found that among veterans enrolled in the VA, more than 1 in 10 have received a low-value service from VA facilities or VACC programs, with approximately $200 million in associated costs. Such information on the use and costs of low-value services are essential to guide the VA\u2019s efforts to reduce delivery and spending on such care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2022.2482","type":"journal-article","created":{"date-parts":[[2022,7,5]],"date-time":"2022-07-05T11:02:42Z","timestamp":1657018962000},"page":"832","source":"Crossref","is-referenced-by-count":27,"title":["Use and Cost of Low-Value Health Services Delivered or Paid for by the Veterans Health Administration"],"prefix":"10.1001","volume":"182","author":[{"given":"Thomas R.","family":"Radomski","sequence":"first","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"},{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinhua","family":"Zhao","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elijah Z.","family":"Lovelace","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florentina E.","family":"Sileanu","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam","family":"Rose","sequence":"additional","affiliation":[{"name":"Health Economics Resource Center, VA Palo Alto Healthcare System, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron L.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, Crescenz VA Medical Center, Philadelphia, Pennsylvania"},{"name":"Department of Medical Ethics and Health Policy and Division of General Internal Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loren J.","family":"Schleiden","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison H.","family":"Oakes","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee N.","family":"Pickering","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"},{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Yang","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer A.","family":"Hale","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid F.","family":"Gellad","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"},{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Fine","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"},{"name":"Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn T.","family":"Thorpe","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pennsylvania"},{"name":"Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill Eshelman School of Pharmacy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10","key":"ioi220035r1","doi-asserted-by":"publisher","first-page":"1401","DOI":"10.1001\/jamainternmed.2018.3573","article-title":"Development of a conceptual map of negative consequences for patients of overuse of medical tests and treatments.","volume":"178","author":"Korenstein","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"15","key":"ioi220035r2","doi-asserted-by":"publisher","first-page":"1501","DOI":"10.1001\/jama.2019.13978","article-title":"Waste in the US health care system: estimated costs and potential for savings.","volume":"322","author":"Shrank","year":"2019","journal-title":"JAMA"},{"issue":"8","key":"ioi220035r3","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1212\/WNL.0000000000002963","article-title":"Neuroimaging overuse is more common in Medicare compared with the 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