{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:11:15Z","timestamp":1793157075718,"version":"4.5.0"},"reference-count":56,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec id=\"ab-ioi260039-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Low-value services (LVSs) remain common and account for a substantial amount of wasteful US health care spending.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260039-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess whether LVS use is associated with physicians\u2019 general clinical knowledge as measured by performance on the American Board of Internal Medicine\u2019s Longitudinal Knowledge Assessment (LKA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260039-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This cross-sectional study included  general internists enrolled in the LKA in 2022 or 2023 caring for Medicare fee-for-service beneficiaries aged 67 years or older in an outpatient setting during their first year of participation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260039-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Physician first-year LKA scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260039-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Receiving any of 25 LVSs designed to measure low-value primary care. Patient level regressions were adjusted for patient demographics, comorbidities, physician practice characteristics, and patient location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260039-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 898\u202f365 included patients, 59% were female with a mean (SE) age of 76.8 (0.02) years, and 30% received at least 1 LVS. Of 7089 physicians, 3568 (50%) were male with a mean (SE) age of 52.5 (0.1) years. Having a physician with a top vs bottom quartile LKA score was associated with a logistic-regression adjusted 7.9% lower (95% CI, \u221210.5% to \u22125.3%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) chance of receiving any LVS during the year (bottom: 31.0% [95% CI, 30.4% to 31.7%]; top: 28.6% [95% CI, 28.1% to 29.1%]); absolute difference: \u22122.5 percentage points (95% CI, \u22123.3 to \u22121.6,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001). Significant differences were observed by LVS subtype including diagnostic or preventive testing (bottom: 10.4% [95% CI, 9.8% to 11.0%], top: 8.7% [95% CI, 8.3% to 9.1%]; absolute difference: \u22121.7 percentage points [95% CI, \u22122.5 to \u22120.9];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), cancer screening (bottom: 13.8% [95% CI, 13.4% to 14.3%], top: 12.3% [95% CI, 11.9% to 12.7%]; absolute difference: \u22121.5 [\u22122.1 to \u22120.9],\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001), and imaging (bottom: 13.8% [95% CI, 13.4% to 14.2%]; top: 13.2% [95% CI, 12.9% to 13.5%]; absolute difference: \u22120.6 [95% CI, \u22121.1 to \u22120.1];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.02). LKA score quartile differences for individual LVSs were most prominent for total and free triiodothyronine testing in patients with hypothyroidism and prostate-specific antigen testing in males 75 aged years and older.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi260039-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>The findings of this cross-sectional study suggest patients cared for by physicians with higher first-year LKA scores were less likely to receive LVSs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2026.2889","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T15:00:29Z","timestamp":1783954829000},"page":"1145","source":"Crossref","is-referenced-by-count":2,"title":["Low-Value Services and Longitudinal Knowledge Assessment 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