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Cascades of Care

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Cascades of Care

  • Definitions
  1. Cascades of Care
    1. Tests beget more tests
    2. Broad, non-focused evaluation may results in False Positives and unexpected incidental findings
    3. These findings trigger escalating levels of testing and evaluation
    4. The added testing often increases risk, cost and anxiety without patient benefit
  • Diagnostics
  • Examples
  1. Incidentalomas (e.g. CT findings)
    1. Small Pulmonary Nodules
    2. Small Adrenal Adenomas
  2. Incidental findings on tests done without indication
    1. Electrocardiogram prior to Cataract surgery (and other low risk surgeries)
    2. Urinalysis during routine physical exam (without other indications)
  • Precautions
  1. Avoid testing done to exclude every possible diagnosis (often for medicolegal protection)
  2. Use Patient Communication and Informed Consent to direct a reasonable testing strategy
  • References
  1. Ganguli (2019) JAMA Netw Open 2(10): e1913325 [PubMed]
  2. Ganguli (2019) JAMA Intern Med 179(9): 1211-9 [PubMed]
  3. Webster (2014) Spine 39(17): 1433-40 [PubMed]