Hopkins study finds large, possibly wasteful differences in endoscopy

More 'bidirectional' procedures would improve the value of American health care, says the JAMA Internal Medicine editorial

Researchers at Johns Hopkins found major differences in the rate of different-day endoscopy among practice settings, a variation that an accompanying editorial could point to another opportunity for improving the value of American heath care.

In findings published this week in JAMA Internal Medicine, Peiqi Wang and her Johns Hopkins colleagues reported that physician offices had a 3.5-fold higher rate of "different-day" endoscopies than hospital outpatient departments. The different-day endoscopy rate at ambulatory surgery centers was also significantly higher. 

In many cases, patients who need an upper and lower endoscopy should have them during the same visit because a "bidirectional" procedure reduces the risk of sedation and is more convenient for patients, according to the editorial by University of Michigan's Andrew M. Ibrahim and Sameer Saini. Yet the procedures are often done on different days. Assessing medical procedures and increasing the rates of preferred ones like bidirectional endoscopy would be another way to improve the value of American health care in addition to the lowering the frequency of "low-effect" tests and reducing the price of services, wrote Ibrahim and Saini.