Identifying low‐value care: the Royal Australasian College of Physicians' EVOLVE initiative

Soon, Jason; Buchbinder, Rachelle; Close, Jacqui; Hill, Catherine J.; Allan, Simon; Turnour, Caroline

doi:10.5694/mja15.01398

Cited by 17 publications

(27 citation statements)

References 6 publications

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“…1 RACP specialties participate by producing a list of their 'top five' low-value practices to lay the ground for clinical change. 2 In 2016, the RACP's Paediatrics and Child Health Division (PCHD) produced a top five list for general paediatrics. To kickstart the process, JS compiled a list of all paediatric-related clinical practices already identified as 'low value' by other RACP specialties and similar initiatives in Australia and overseas (http://www.evolve.edu.au; http://www.choosingwisely.org; http://www.choosingwisely.org.au; and https://www.nice.org.…”

Section: Dear Editor the Racp Evolve General Paediatrics Listmentioning

confidence: 99%

The Racp Evolve General Paediatrics List

Dalton

Soon

2017

J Paediatrics Child Health

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Section: Dear Editor the Racp Evolve General Paediatrics Listmentioning

confidence: 99%

The Racp Evolve General Paediatrics List

Dalton

Soon

2017

J Paediatrics Child Health

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“…This program aspires to be a transparent and consistent process of speciality-wide consultation, in collaboration with patient representatives to nominate specialty-based ‘top 5 lists’ of low-value practices based on evidence [12] and shared values [7]. There are a number of other similar current initiatives detailing low-value practices within medicine such as the Royal Australasian College of Physicians’ EVOLVE program, the British Medical Journal’s Too Much Medicine series and the Journal of the American Medical Association’s Less is More series [13–15]. …”

Section: Introductionmentioning

confidence: 99%

A methodological protocol for selecting and quantifying low-value prescribing practices in routinely collected data: an Australian case study

et al. 2017

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BackgroundGrowing imperatives for safety, quality and responsible resource allocation have prompted renewed efforts to identify and quantify harmful or wasteful (low-value) medical practices such as test ordering, procedures and prescribing. Quantifying these practices at a population level using routinely collected health data allows us to understand the scale of low-value medical practices, measure practice change following specific interventions and prioritise policy decisions. To date, almost all research examining health care through the low-value lens has focused on medical services (tests and procedures) rather than on prescribing. The protocol described herein outlines a program of research funded by Australia’s National Health and Medical Research Council to select and quantify low-value prescribing practices within Australian routinely collected health data.MethodsWe start by describing our process for identifying and cataloguing international low-value prescribing practices. We then outline our approach to translate these prescribing practices into indicators that can be applied to Australian routinely collected health data. Next, we detail methods of using Australian health data to quantify these prescribing practices (e.g. prevalence of low-value prescribing and related costs) and their downstream health consequences. We have approval from the necessary Australian state and commonwealth human research ethics and data access committees to undertake this work.DiscussionThe lack of systematic and transparent approaches to quantification of low-value practices in routinely collected data has been noted in recent reviews. Here, we present a methodology applied in the Australian context with the aim of demonstrating principles that can be applied across jurisdictions in order to harmonise international efforts to measure low-value prescribing. The outcomes of this research will be submitted to international peer-reviewed journals. Results will also be presented at national and international pharmacoepidemiology and health policy forums such that other jurisdictions have guidance to adapt this methodology.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0585-9) contains supplementary material, which is available to authorized users.

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“…In relation to melanoma in situ, we agree completely with the Evaluating Evidence Enhancing Efficiences (EVOLVE) guidelines2 that there is no evidence that sentinel node (SN) biopsy for this entity is beneficial and also agree that it would constitute low-value care if performed. However, there appears to be a serious methodological flaw in the study by Badgery-Parker et al which may have led to the erroneous claim that SN biopsy for melanoma in situ is being performed in NSW public hospitals and ‘requires action to reverse increasing trends’.…”

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confidence: 81%