Exploring unnecessary invasive procedures in the United States

A retrospective mixed-methods analysis of cases from 2008-2016

James M. DuBois, John T. Chibnall, Emily E. Anderson, Heidi A. Walsh, Michelle Eggers, Kari Baldwin, Kelly K. Dineen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Unnecessary invasive procedures risk harming patients physically, emotionally, and financially. Very little is known about the factors that provide the motive, means, and opportunity (MMO) for unnecessary procedures. Methods: This project used a mixed-methods design that involved five key steps: (1) systematically searching the literature to identify cases of unnecessary procedures reported from 2008 to 2016; (2) identifying all medical board, court, and news records on relevant cases; (3) coding all relevant records using a structured codebook of case characteristics; (4) analyzing each case using a MMO framework to develop a causal theory of the case; and (5) identifying typologies of cases through a two-step cluster analysis using variables hypothesized to be causally related to unnecessary procedures. Results: Seventy-nine cases met inclusion criteria. The mean number of documents or sources examined for each case was 36.4. Unnecessary procedures were performed for at least five years in most cases (53.2%); 56.3% of the cases involved 30 or more patients, and 37.5% involved 100 or more patients. In nearly all cases the physician was male (96.2%) and working in private practice (92.4%); 57.0% of the physicians had an accomplice, 48.1% were 50 years of age or older, and 40.5% trained outside the U.S. The most common motives were financial gain (92.4%) and suspected antisocial personality (48.1%), followed by poor problem-solving or clinical skills (11.4%) and ambition (3.8%). The most common environmental factors that provided opportunity for unnecessary procedures included a lack of oversight (40.5%) or oversight failures (39.2%), a corrupt moral climate (26.6%), vulnerable patients (20.3%), and financial conflicts of interest (13.9%). Conclusions: Unnecessary procedures usually appear motivated by financial gain and occur in settings that have oversight problems. Preventive efforts should focus on early detection by peers and institutions, and decisive action by medical boards and federal prosecutors.

Original languageEnglish (US)
Article number30
JournalPatient Safety in Surgery
Volume11
Issue number1
DOIs
StatePublished - Dec 18 2017
Externally publishedYes

Fingerprint

Unnecessary Procedures
Physicians
Antisocial Personality Disorder
Conflict of Interest
Clinical Competence
Private Practice
Climate
Cluster Analysis

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Anesthesiology and Pain Medicine

Cite this

Exploring unnecessary invasive procedures in the United States : A retrospective mixed-methods analysis of cases from 2008-2016. / DuBois, James M.; Chibnall, John T.; Anderson, Emily E.; Walsh, Heidi A.; Eggers, Michelle; Baldwin, Kari; Dineen, Kelly K.

In: Patient Safety in Surgery, Vol. 11, No. 1, 30, 18.12.2017.

Research output: Contribution to journalArticle

DuBois, James M. ; Chibnall, John T. ; Anderson, Emily E. ; Walsh, Heidi A. ; Eggers, Michelle ; Baldwin, Kari ; Dineen, Kelly K. / Exploring unnecessary invasive procedures in the United States : A retrospective mixed-methods analysis of cases from 2008-2016. In: Patient Safety in Surgery. 2017 ; Vol. 11, No. 1.
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abstract = "Background: Unnecessary invasive procedures risk harming patients physically, emotionally, and financially. Very little is known about the factors that provide the motive, means, and opportunity (MMO) for unnecessary procedures. Methods: This project used a mixed-methods design that involved five key steps: (1) systematically searching the literature to identify cases of unnecessary procedures reported from 2008 to 2016; (2) identifying all medical board, court, and news records on relevant cases; (3) coding all relevant records using a structured codebook of case characteristics; (4) analyzing each case using a MMO framework to develop a causal theory of the case; and (5) identifying typologies of cases through a two-step cluster analysis using variables hypothesized to be causally related to unnecessary procedures. Results: Seventy-nine cases met inclusion criteria. The mean number of documents or sources examined for each case was 36.4. Unnecessary procedures were performed for at least five years in most cases (53.2{\%}); 56.3{\%} of the cases involved 30 or more patients, and 37.5{\%} involved 100 or more patients. In nearly all cases the physician was male (96.2{\%}) and working in private practice (92.4{\%}); 57.0{\%} of the physicians had an accomplice, 48.1{\%} were 50 years of age or older, and 40.5{\%} trained outside the U.S. The most common motives were financial gain (92.4{\%}) and suspected antisocial personality (48.1{\%}), followed by poor problem-solving or clinical skills (11.4{\%}) and ambition (3.8{\%}). The most common environmental factors that provided opportunity for unnecessary procedures included a lack of oversight (40.5{\%}) or oversight failures (39.2{\%}), a corrupt moral climate (26.6{\%}), vulnerable patients (20.3{\%}), and financial conflicts of interest (13.9{\%}). Conclusions: Unnecessary procedures usually appear motivated by financial gain and occur in settings that have oversight problems. Preventive efforts should focus on early detection by peers and institutions, and decisive action by medical boards and federal prosecutors.",
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AB - Background: Unnecessary invasive procedures risk harming patients physically, emotionally, and financially. Very little is known about the factors that provide the motive, means, and opportunity (MMO) for unnecessary procedures. Methods: This project used a mixed-methods design that involved five key steps: (1) systematically searching the literature to identify cases of unnecessary procedures reported from 2008 to 2016; (2) identifying all medical board, court, and news records on relevant cases; (3) coding all relevant records using a structured codebook of case characteristics; (4) analyzing each case using a MMO framework to develop a causal theory of the case; and (5) identifying typologies of cases through a two-step cluster analysis using variables hypothesized to be causally related to unnecessary procedures. Results: Seventy-nine cases met inclusion criteria. The mean number of documents or sources examined for each case was 36.4. Unnecessary procedures were performed for at least five years in most cases (53.2%); 56.3% of the cases involved 30 or more patients, and 37.5% involved 100 or more patients. In nearly all cases the physician was male (96.2%) and working in private practice (92.4%); 57.0% of the physicians had an accomplice, 48.1% were 50 years of age or older, and 40.5% trained outside the U.S. The most common motives were financial gain (92.4%) and suspected antisocial personality (48.1%), followed by poor problem-solving or clinical skills (11.4%) and ambition (3.8%). The most common environmental factors that provided opportunity for unnecessary procedures included a lack of oversight (40.5%) or oversight failures (39.2%), a corrupt moral climate (26.6%), vulnerable patients (20.3%), and financial conflicts of interest (13.9%). Conclusions: Unnecessary procedures usually appear motivated by financial gain and occur in settings that have oversight problems. Preventive efforts should focus on early detection by peers and institutions, and decisive action by medical boards and federal prosecutors.

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