Study maps hotspots of low-value care use in individual health systems

Researchers estimate that up to $ 101 billion in health care spending is wasted each year due to overtreatment or the provision of “low-value care.” Low-value care includes a wide range of tests and treatments that are medically unnecessary and where the potential for harm outweighs the potential for benefit. While researchers have mapped the continued use of low-value care at national and regional levels, there is little research on how health systems across the country are using low-value care and how they stack up against them. to each other. A new study by researchers at Brigham and Women’s Hospital and the Dartmouth Institute for Health Policy and Clinical Practice examined the use of 41 low-value services in 556 U.S. healthcare systems. Their results, published in JAMA Internal Medicine, map the hotspots of low-value care use in individual health systems and shed light on the predictors of this use.

More and more Americans are receiving care from health systems rather than stand-alone practices. Given actionable data, these systems have enormous potential to influence decision-making on low-value care. We hope that this work can motivate systems to measure and intervene internally on low-value care. “

Ishani Ganguli MD, MPH, lead study author and researcher, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital

Ishani Ganguli is also an Assistant Professor of Medicine at Harvard Medical School.

The researchers found that preoperative laboratory tests in healthy patients before low-risk surgeries, screening for prostate cancer in men over 70, and the use of antipsychotic drugs in patients with dementia were the most common forms of low-value care among those studied. Preoperative laboratory tests, for example, are not recommended because they do not improve surgical results and may show false alarms, among other problems.

Researchers have identified a range of factors associated with health systems whose patients have received less valuable care. The systems tended to have a smaller share of primary care physicians, no associated teaching hospitals, head offices located in the South or West (compared to the Northeast or Midwest), and proportionately more patients belonging to racial and ethnic minorities. The use of low-value care was also correlated with an increase in overall health expenditure in the region.

To conduct their study, the authors looked at national data on claims from Medicare beneficiaries over 65 and linked each to a health system based on where they received their plurality of primary care. Based on previous definitions of 41 low-value services, the researchers measured the use of each of these services among eligible patients for the given service. Then, they combined the 28 most common low-value services to create composite low-value care scores to compare systems.

The researchers note the limitations of their study. For example, health insurance claim data does not contain the clinical details to confirm why a doctor would have ordered a certain test or procedure for a patient. And the estimates only capture a snapshot of low-value services over a given time period. Nevertheless, they hope that this work could help health systems intervene on the use of low-value care, for example through employee training, clinical decision support systems, modification of workplace culture or adjustment of reimbursement models.

Source:

Journal reference:

Ganguli, I., et al. (2021) Low-value care at the actionable level of individual health systems. JAMA Internal Medicine. doi.org/10.1001/jamainternmed.2021.5531.


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Norma A. Roth