Cascade effects of medical technology

Research output: Contribution to journalReview article

124 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)23-44
Number of pages22
JournalAnnual Review of Public Health
Volume23
DOIs
StatePublished - May 23 2002

Keywords

  • Adverse effects
  • Diagnostic tests
  • Quality-of-care
  • Technology

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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