An Evidence Review of Low-Value Care Recommendations: Inconsistency and Lack of Economic Evidence Considered

Kim, David D.; Lauren, A; Daly, Allan T.; Wong, John B.; Chambers, James D.; Ollendorf, Daniel A.; Neumann, Peter J.

doi:10.1007/s11606-021-06639-2

Cited by 15 publications

(16 citation statements)

References 40 publications

(32 reference statements)

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“…To directly measure LvC, clinical evidence-based guidelines and consensus-based expert publications were used, resulting in the following two limitations: First, the expert lens did not consider the patient perspective, such as LvC as unwanted care, and second, there is a lack of economic evidence in LvC recommendations, overemphasizing clinical rationales, as recently stated by Kim et al [56]. Generally, the classification of treatment as LvC depends on the context of healthcare provision and, in particular, the diagnosis, which only 40% of PwD had at the time of the screening procedure before starting the baseline assessment.…”

Section: Limitationsmentioning

confidence: 99%

Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia

Platen

Fleßa

Rädke

et al. 2021

JAD

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Background: Low-value care (LvC) is defined as care unlikely to provide a benefit to the patient regarding the patient’s preferences, potential harms, costs, or available alternatives. Avoiding LvC and promoting recommended evidence-based treatments, referred to as high-value care (HvC), could improve patient-reported outcomes for people living with dementia (PwD). Objective: This study aims to determine the prevalence of LvC and HvC in dementia and the associations of LvC and HvC with patients’ quality of life and hospitalization. Methods: The analysis was based on data of the DelpHi trial and included 516 PwD. Dementia-specific guidelines, the “Choosing Wisely” campaign and the PRISCUS list were used to indicate LvC and HvC treatments, resulting in 347 LvC and HvC related recommendations. Of these, 77 recommendations (51 for LvC, 26 for HvC) were measured within the DelpHi-trial and finally used for this analysis. The association of LvC and HvC treatments with PwD health-related quality of life (HRQoL) and hospitalization was assessed using multiple regression models. Results: LvC was highly prevalent in PwD (31%). PwD receiving LvC had a significantly lower quality of life (b = –0.07; 95%CI –0.14––0.01) and were significantly more likely to be hospitalized (OR = 2.06; 95%CI 1.26–3.39). Different HvC treatments were associated with both positive and negative changes in HRQoL. Conclusion: LvC could cause adverse outcomes and should be identified as early as possible and tried to be replaced. Future research should examine innovative models of care or treatment pathways supporting the identification and replacement of LvC in dementia.

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Section: Limitationsmentioning

confidence: 99%

Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia

Platen

Fleßa

Rädke

et al. 2021

JAD

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“…Researchers have noted that patient factors are significant to the maintenance of LVC as well as cultural and historical factors [8][9][10]. The goals of de-implementing LVC are removing or reducing patient harm, maximizing efficient use of resources and improving population health [4,11,12].…”

Section: Introductionmentioning

confidence: 99%

Understanding low-value care and associated de-implementation processes: a qualitative study of Choosing Wisely Interventions across Canadian hospitals

Parker

Kastner

Born

et al. 2022

BMC Health Serv Res

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Background Choosing Wisely (CW) is an international movement comprised of campaigns in more than 20 countries to reduce low-value care (LVC). De-implementation, the reduction or removal of a healthcare practice that offers little to no benefit or causes harm, is an emerging field of research. Little is known about the factors which (i) sustain LVC; and (ii) the magnitude of the problem of LVC. In addition, little is known about the processes of de-implementation, and if and how these processes differ from implementation endeavours. The objective of this study was to explicate the myriad factors which impact the processes and outcomes of de-implementation initiatives that are designed to address national Choosing Wisely campaign recommendations. Methods Semi-structured interviews were conducted with individuals implementing Choosing Wisely Canada recommendations in healthcare settings in four provinces. The interview guide was developed using concepts from the literature and the Implementation Process Model (IPM) as a framework. All interviews were conducted virtually, recorded, and transcribed verbatim. Data were analysed using thematic analysis. Findings Seventeen Choosing Wisely team members were interviewed. Participants identified numerous provider factors, most notably habit, which sustain LVC. Contrary to reporting in recent studies, the majority of LVC in the sample was not ‘patient facing’; therefore, patients were not a significant driver for the LVC, nor a barrier to reducing it. Participants detailed aspects of the magnitude of the problems of LVC, providing insight into the complexities and nuances of harm, resources and prevalence. Harm from potential or common infections, reactions, or overtreatment was viewed as the most significant types of harm. Unique factors influencing the processes of de-implementation reported were: influence of Choosing Wisely campaigns, availability of data, lack of targets and hard-coded interventions. Conclusions This study explicates factors ranging from those which impact the maintenance of LVC to factors that impact the success of de-implementation interventions intended to reduce them. The findings draw attention to the significance of unintentional factors, highlight the importance of understanding the impact of harm and resources to reduce LVC and illuminate the overstated impact of patients in de-implementation literature. These findings illustrate the complexities of de-implementation.

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“…One explanation is that "insufficient evidence" is regarded as similar to "do not recommend", so the revised recommendation might not have differently affected the targeted group of the aged 70-74. 10 We found an immediate 16% decrease in odds of PSA screening for age group 70+ after the publication of the 2012 recommendations. Previous studies based on self-reported National Health Interview Survey data in 2010 and 2013 found that PSA rates decreased by 5-25% (odds: 15-34%) among those aged 50 and above.…”

Section: Discussionmentioning

confidence: 72%

“…Our findings suggest that both age groups equally responded (or equally did not respond) to the 2012 revised recommendations. One explanation is that “insufficient evidence” is regarded as similar to “do not recommend”, so the revised recommendation might not have differently affected the targeted group of the aged 70–74 10…”

Section: Discussionmentioning

confidence: 99%

Effect of the 2012 US Preventive Services Task Force Recommendations on Prostate-Specific Antigen Screening in a Medicare Advantage Population

Zhu¹,

Koethe

Ollendorf

et al. 2022

Medical Care

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Background: In 2012, the US Preventive Service Task Force revised its recommendations for prostate-specific antigen (PSA) screening from "insufficient evidence" to "do not recommend" for men aged 70-74 while maintaining "do not recommend" for men aged 75+.Methods: Using the difference-in-difference approach, we evaluated whether the rate of change in the use of low-value PSA screening differed between the control group (men aged 75+, N = 7,856,204 person-years) and the intervention group (men aged 70-74, N = 5,329,192 person-years) enrolling in the Medicare Advantage plan without a history of prostate cancer within the OptumLabs Data Warehouse claims data (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019). A generalized estimating equation logistic model was specified with independent variables: an intervention group indicator, a pre-and post-period (after 2012 Q2) indicator, index time, and interaction terms. We assumed a 12-month dissemination period.Results: Before the revised recommendation in 2012, the trends did not significantly differ between the 2 age groups with the odds of receiving PSA screening decreasing by 1.2% (95% confidence interval [1.0, 1.4%]) per quarter. However, the odds of receiving PSA screening increased by 3.0% [2.8, 3.2%] per quarter across both groups since the revision. There was no significant additional change in the trend for those aged 70-74 (0.1% [−0.2, 0.5%]).Conclusions: Although the 2012 US Preventive Service Task Force's recommendations were expected to only change behaviors among men aged 70-74, our analysis found that men aged 70-74 and aged 75+ exhibited similar trends from 2009 to 2019, including the increased use of low-value PSA screening since 2016. Multifaceted efforts to discourage low-value PSA screening would be important for a sustained impact.

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An Evidence Review of Low-Value Care Recommendations: Inconsistency and Lack of Economic Evidence Considered

Cited by 15 publications

References 40 publications

Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia

Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia

Understanding low-value care and associated de-implementation processes: a qualitative study of Choosing Wisely Interventions across Canadian hospitals

Effect of the 2012 US Preventive Services Task Force Recommendations on Prostate-Specific Antigen Screening in a Medicare Advantage Population

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