Accepted for Publication: February 7, 2014.
Published Online: May 12, 2014. doi:10.1001/jamainternmed.2014.1541.
Study concept and design: All authors.
Acquisition of data: Schwartz, McWilliams.
Analysis and interpretation of data: Elshaug, Chernew, McWilliams.
Drafting of the manuscript: Schwartz, Elshaug, McWilliams.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Schwartz, McWilliams.
Obtained funding: McWilliams.
Administrative, technical, or material support: Schwartz, McWilliams.
Study supervision: Elshaug, Chernew, McWilliams.
Conflict of Interest Disclosures: Dr Chernew reports that he is a partner in VBID Health, LLC, which has a contract with Milliman to develop and market a tool to help insurers and employers quantify spending on low-value services. Dr Elshaug reports that he provides advice to the Australian Government Department of Health on policy responses to low-value health care. Mr Schwartz and Drs Landon and McWilliams report no conflicts.
Funding/Support: This work was supported by grants from the Beeson Career Development Award Program (National Institute on Aging grant K08 AG038354 and the American Federation for Aging Research), the Doris Duke Charitable Foundation (Clinical Scientist Development Award 2010053), the National Institute on Aging (grant P01 AG032952), the Agency for Healthcare Research and Quality (Institutional Training Grant 2T32HS000055-20), Harvard University (Christopher G. P. Walker Fellowship), and the Australian National Health and Medical Research Council (Sidney Sax Public Health Fellowship 627061).
Role of the Sponsor: The funding sources did not play a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; or decision to submit the manuscript for publication.
Additional Contributions: We are grateful to Joseph P. Newhouse, PhD, and Frank Levy, PhD, for comments on an earlier draft of the manuscript. Drs Newhouse and Levy were not compensated for their contributions.