TY - JOUR T1 - How can routine colorectal cancer screening in the USA be considered low value in other countries? JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2022-015576 SP - bmjqs-2022-015576 AU - Kelsey Chalmers AU - Shannon Brownlee AU - Vikas Saini Y1 - 2023/03/13 UR - http://qualitysafety.bmj.com/content/early/2023/03/12/bmjqs-2022-015576.abstract N2 - Low-value services and healthcare overuse are tests, treatments or other medical interventions that provide little to no benefit to patients relative to their risk of harm, their costs and the availability of alternatives.1 Researchers investigating overuse usually base their measures on compliance with some defined standard of care, which can be country or region specific. In some countries, these standards might be based on trade-offs between population costs and outcomes. However, this is often not the case in the USA.2 For example, colonoscopy for the screening of colorectal cancer is routine care in the US, while other countries' national standards of care recommend against its use due to the availability of alternative methods that are less invasive and less costly. In this editorial, we consider why differences exist in what is considered overuse in light of a recently published US-based measure of colonoscopy screening overuse.In this issue of BMJ Quality and Safety,3 Adams and colleagues outline a lengthy process to develop and validate a measure for identifying overuse of screening colonoscopy in the US Department of Veterans Affairs (VA) health system. The VA system covers retired military personnel, who receive most of their care from VA facilities and clinicians. In a collaborative effort with clinicians and medical coders, the authors updated a previous screening colonoscopy overuse algorithm from the 9th edition of the International Classification of Diseases (ICD) to the 10th edition. ICD-10 has been used in US insurance claims since 2015, and includes many more codes than the ninth edition, and therefore more specificity in described conditions. After creating the electronic algorithm, the authors selected a random sample of cases to validate it using chart review and found very good agreement between the algorithm and chart review results. Adams and colleagues encourage use of … ER -