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Semin Med Pract 
2001 Dec;4(4):6-25
The care path not taken: the paradox of underused proven treatments
Silverman DC, Yetman RJ

Significant defects have been identified in the health care that is routinely delivered in the United States. Of all health care defects, underuse of proven effective interventions is perhaps the most paradoxical, because it occurs in an era of both explosive growth in medical knowledge and extravagant use of diagnostic techniques, expensive technologies, and novel therapeutic agents that often do not significantly improve outcomes. Furthermore, underuse is disturbingly common, affects all populations of patients, and is associated with a broad array of clinical conditions. In this article, the authors review relevant literature supporting some of the most profound examples of underuse that have been documented in this country. In addition, factors that may contribute to underuse are considered and areas on which to focus improvement efforts are discussed.

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