# Towards Reduction of Harmful Overuse of Healthcare in Older Adults

> **NIH NIH K24** · JOHNS HOPKINS UNIVERSITY · 2021 · $153,902

## Abstract

Project Summary
Although there has been remarkable progress since the National Academy of Medicine’s report in 2013
describing a path towards Best Care at Lower Cost, we are not where we need to be. My research agenda
is to conduct patient-oriented research that advances our understanding of overuse of healthcare among
older adults. With the collaboration of junior investigators and other mentees, I will conduct research to
understand how health care systems reduce the harmful overuse of healthcare resources by their
Medicare beneficiaries through their delivery of high quality primary care. In the last four years of my
funded work, my team and I have come to recognize that there is not yet a comprehensive understanding
of drivers of overuse at the levels of the patient, clinician, and system, and the most optimal points for
interventions are not yet defined. We developed the Johns Hopkins Overuse Index which is an index of 20
procedures that can measure regional variation in the overuse of healthcare resource. The index has been
useful as an outcome measure and has allowed us to demonstrate the beneficial impact of higher regional
density of primary care doctors on reducing overuse both among Medicare beneficiaries and younger,
commercially insured people. I seek to understand the mechanisms by which high quality primary care
reduces overuse of resources in older adults through a mixed-methods evaluation of positively deviating
health systems and through modeling components of primary care delivery with mediation analysis
methods.
I also aim to improve the decisions made in the care of older adults by addressing a fundamental problem:
that unappreciated heterogeneity of treatment effect (HTE) contributes to overuse of healthcare in older
adults. Older adults are at particularly high risk of overuse of healthcare; this is both a discrete
subpopulation of all adults, and a population with great variation amongst itself. Contributors to this
variation include physiological differences attributable to marked variances in the aging process across
individuals that manifests as frailty or robustness, as well as differences that arise due to the degree of
multimorbidity, older adults’ preferences regarding interventions, and their ability to engage in self-care.
The second proposed set of projects will involve the development of methods and tools to help clinicians
to communicate more clearly with each other and with patients on this topic. With use of Design Thinking
methods and engagement of collaborators from our Department of Art as Applied to Medicine, I will
develop a framework and visual tools to assist with clear communication on this topic.

## Key facts

- **NIH application ID:** 10153604
- **Project number:** 5K24AG049036-07
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** JODI B. SEGAL
- **Activity code:** K24 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $153,902
- **Award type:** 5
- **Project period:** 2015-09-01 → 2025-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10153604

## Citation

> US National Institutes of Health, RePORTER application 10153604, Towards Reduction of Harmful Overuse of Healthcare in Older Adults (5K24AG049036-07). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10153604. Licensed CC0.

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