Article

Cascade Effects of Medical Technology

Center for Costs and Outcomes Research, University of Washington, 146 North Canal Street, Suite 300, Seattle, Washington 98103-8652, USA.
Annual Review of Public Health (Impact Factor: 6.63). 02/2002; 23(1):23-44. DOI: 10.1146/annurev.publhealth.23.092101.134534
Source: PubMed

ABSTRACT Cascade effect refers to a process that proceeds in stepwise fashion from an initiating event to a seemingly inevitable conclusion. With regard to medical technology, the term refers to a chain of events initiated by an unnecessary test, an unexpected result, or patient or physician anxiety, which results in ill-advised tests or treatments that may cause avoidable adverse effects and/or morbidity. Examples include discovery of endocrine incidentalomas on head and body scans; irrelevant abnormalities on spinal imaging; tampering with random fluctuations in clinical measures; and unwanted aggressive care at the end of life. Common triggers include failing to understand the likelihood of false-positive results; errors in data interpretation; overestimating benefits or underestimating risks; and low tolerance of ambiguity. Excess capacity and perverse financial incentives may contribute to cascade effects as well. Preventing cascade effects may require better education of physicians and patients; research on the natural history of mild diagnostic abnormalities; achieving optimal capacity in health care systems; and awareness that more is not the same as better.

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