In this issue of JAMA Internal Medicine, Resnick and colleagues¹ test the hypothesis that Medicare Accountable Care Organizations (ACOs) are associated with changes in cancer screening among beneficiaries. Accountable Care Organizations are intended to provide incentives for care coordination and promote high-quality care. In addition, measures for underuse of breast and colorectal cancer screening are routinely used to evaluate ACO quality of care. While no measures specifically address overuse of cancer screening, ACOs are responsible for downstream negative effects from overscreening—harms from the test, overdiagnosis, and overtreatment. Therefore, one would expect ACOs to increase cancer screening when appropriate and reduce cancer screening when inappropriate, reducing both underuse and overuse.

在本期《JAMA内科医学》中，Resnick及其同事¹检验医疗保险责任医疗组织（ACO）与受益人癌症筛查变化有关的假设。负责任的护理组织旨在提供激励措施，以促进护理协调并促进高质量护理。另外，常规使用对乳腺癌和结肠直肠癌筛查不足的措施来评估ACO的护理质量。尽管没有专门针对过度使用癌症筛查的措施，但是ACO会导致过度筛查对下游产生的负面影响，即测试，过度诊断和过度治疗的危害。因此，人们希望ACO在适当的时候增加对癌症的筛查，在不适当的时候减少对癌症的筛查，从而减少使用不足和过度使用。