Frequency of and variation in low-value care in primary care: a retrospective cohort study

Pendrith, Ciara; Bhatia, M L; Ivers, Noah; Mecredy, Graham; Tu, Karen; Hawker, Gillian; Jaglal, Susan; Wilson, Lynn; Wintemute, Kimberly; Glazier, Richard H.; Levinson, Wendy; Bhatia, R Sacha

doi:10.9778/cmajo.20160095

Cited by 25 publications

(57 citation statements)

References 15 publications

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“…In fact, routine chest x-ray use appears to be appreciably less common than other forms of low-value imaging we have previously studied. 12,23,31 Our study underscores the importance of establishing baseline estimates to compare frequency of use across different tests and clinical scenarios, which can provide health care decisionmakers with a basis for determining which tests they might preferentially target with quality improvement initiatives aimed at reducing low-value care. 32 The observed decline in routine chest x-ray use over time may be due to increased recognition among physicians of the limited utility of chest x-rays for screening asymptomatic, low-risk patients, possibly promoted by 2013 OHIP Schedule of Benefits revisions that included recommendations against routine chest x-ray reimbursement and new PHE codes to reduce low-value testing.…”

Section: Discussionmentioning

confidence: 90%

“…Substantial variation among regions, practices and individual primary care physicians was observed, which is consistent with previous research. 12,22,23,31,32 Significant within-practice variation in having a post-PHE chest x-ray persisted even after we adjusted for several patient and physician characteristics, suggesting that unmeasured practice-level characteristics account for a sizeable portion of the observed variability in routine chest x-ray use. Patients who were older and male were more likely to have a routine chest x-ray.…”

Section: Discussionmentioning

confidence: 98%

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Routine use of chest x-ray for low-risk patients undergoing a periodic health examination: a retrospective cohort study

Bouck

Mecredy

Ivers

et al. 2018

cmajo

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 98%

Routine use of chest x-ray for low-risk patients undergoing a periodic health examination: a retrospective cohort study

Bouck

Mecredy

Ivers

et al. 2018

cmajo

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“…13,14 One study 16 found that prescription NSAID use for musculoskeletal pain management ranged from 14.4% to 16.2% in patients with hypertension, heart failure, or CKD. A study 59 of patients with preexisting cardiovascular disease found that self-reported use of both prescription and over-the-counter NSAIDs was common, particularly among patients with angina or myocardial infarction. Another study 28 found that 5.7% of patients with moderate to severe CKD reported NSAID use; however, use was primarily driven by over-the-counter medications, and many of the patients were unaware of their condition.…”

Section: Discussionmentioning

confidence: 99%

Frequency and Associations of Prescription Nonsteroidal Anti-inflammatory Drug Use Among Patients With a Musculoskeletal Disorder and Hypertension, Heart Failure, or Chronic Kidney Disease

et al. 2018

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societies advise against nonsteroidal anti-inflammatory drug (NSAID) use in patients with hypertension, heart failure, or chronic kidney disease (CKD); however, recent studies have not investigated the frequency or associations of use in these patients.OBJECTIVES To estimate the frequency of and variation in prescription NSAID use among high-risk patients, to identify characteristics associated with prescription NSAID use, and to investigate whether use is associated with short-term, safety-related outcomes. DESIGN, SETTING, AND PARTICIPANTSIn this retrospective cohort study, administrative claims databases were linked to create a cohort of primary care visits for a musculoskeletal disorder involving patients 65 years and older with a history of hypertension, heart failure, or CKD

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“…One of the first accounts was in Australia, for example with ophthalmology services, where administrative data was used to identify geographic and socioeconomic variations in claims and to examine temporal and economic trends over time [ 38 ]. In Canada, significant, practice-level variability in the rates of low-value bone density scans, back pain imaging, and cervical cancer screening was identified through administrative data in the province of Ontario [ 39 ]. Further, administrative data has been used to evaluate the impact of Choosing Wisely recommendations on clinical practice [ 16 , 19 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Moving low value care lists into action: prioritizing candidate health technologies for reassessment using administrative data

Soril

Seixas

Mitton

et al. 2018

BMC Health Serv Res

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BackgroundActive management of existing health technologies (e.g., devices, diagnostic, and/or medical procedures) to ensure the delivery of high value care is increasingly recognized around the world. A number of initiatives have raised awareness of technologies that may be overused, mis-used, or potentially harmful by compiling them into lists of low value care. However, despite the growing number of lists, changes to local healthcare practices remain challenging for many systems. The objective of this study was to develop and implement a process, leveraging existing initiatives and data assets, to produce a list of prioritized low value technologies for health technology reassessment (HTR).MethodsAn expert advisory committee comprised of clinical experts and health system decision-makers was convened to determine key process requirements. Once developed, the process was piloted to assess feasibility in the Canadian province of British Columbia (BC).ResultsThe expert advisory committee identified five required attributes for the process: data-driven, routine and replicable, actionable, stakeholder collaboration, and high return on investment. Guided by these attributes, a 5-step process was developed. First, over 1300 published low value technologies (i.e., from the National Institute for Health and Care Excellence [NICE] “do not do” recommendations, low value technologies in the Australian Medical Benefits Schedule, and Choosing Wisely “Top 5” lists) were identified. Using appropriate coding systems for BC’s administrative health data (e.g., International Classification of Diseases [ICD]), the low value technologies were queried to examine frequencies and costs of technology use. This information was used to rank potential candidates for reassessment based on high annual budgetary impact. Lastly, clinical experts reviewed the ranked technologies prior to broad dissemination and stakeholder action. Pilot testing of the process in BC resulted in the prioritization of 9 initial candidate technologies for reassessment.ConclusionsThis is the first account of a systematic approach to move a collective body of low value technology recommendations into action in a healthcare setting. This work demonstrates the feasibility and strength of using administrative data to identify and prioritize low value technologies for HTR at a population-level.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3459-1) contains supplementary material, which is available to authorized users.

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Frequency of and variation in low-value care in primary care: a retrospective cohort study

Cited by 25 publications

References 15 publications

Routine use of chest x-ray for low-risk patients undergoing a periodic health examination: a retrospective cohort study

Routine use of chest x-ray for low-risk patients undergoing a periodic health examination: a retrospective cohort study

Frequency and Associations of Prescription Nonsteroidal Anti-inflammatory Drug Use Among Patients With a Musculoskeletal Disorder and Hypertension, Heart Failure, or Chronic Kidney Disease

Moving low value care lists into action: prioritizing candidate health technologies for reassessment using administrative data

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