(Reuters Health) – Many patients in the U.S. are receiving care that is low-value, whether it’s unnecessary testing or unneeded prescriptions, but measuring these practices at the level of individual healthcare systems could help in efforts to curtail them, according to a new study.
An analysis of data on 11,637,763 Medicare beneficiaries treated at 556 healthcare systems found that among patients eligible for any of 41 low-value services, 0% to 28% of the patients received them. Health systems with certain characteristics were most likely to deliver low-value care, according to the report published in JAMA Internal Medicine.
With more and more patients receiving care at big health systems, “it’s still far too common for Americans to get low-value medical services: tests and treatments for which the potential for benefit – if any – is outweighed by potential for harm,” said the study’s first author, Dr. Ishani Ganguli, an assistant professor of medicine at the Harvard Medical School and Brigham and Women’s Hospital in Boston.
“We measured the use of 41 of these services in 556 health systems across the U.S. and a composite score of the 28 most common tests so that patients and others can check how their health system compares to others,” Dr. Ganguli said in an email. “Overall, the most common low-value tests were ‘pre-operative’ lab tests before low-risk surgeries. Health systems where the patients received MORE low-value care had smaller shares of primary care physicians, no associated teaching hospital, were headquartered in the South or West, served proportionally more (minority) patients, and served areas that had more health care spending overall.”
Dr. Ganguli hopes the new findings will spark changes.
“We hope that these measurements of low-value care use encourage health systems to measure and reduce this care internally – for example through educating their employees, setting up reminders in the electronic health record, shifting workplace culture, or paying doctors differently,” she said.
To take a closer look at which institutions were using low-value services the most, Dr. Ganguli and her colleagues turned to the 2015-2017 Medicare fee-for-service administration data from the Beneficiary Summary file, claims and administrative records, the Long-Term Care Minimum Data Set and First Databank.
The researchers examined the care of beneficiaries who were older than 65 and enrolled for at least 12 months in Medicare Parts A and B in either 2016 or 2017.They also included a random 40% sample of fee-for-service prescription (Part D) data. Health systems were identified via the AHRQ Compendium.
Among patients eligible for the low-value services, rates of use ranged from 0% to 28%. The most common low-value services were preoperative laboratory testing (mean rate, 28%), prostate-specific antigen testing in men older than 70 years (mean rate, 27%), and use of antipsychotic medications in patients with dementia (mean rate, 24%).
In their multivariable analysis, the researchers found that the health system characteristics associated with higher use of low-value care were: smaller proportion of primary care physicians, no major teaching hospital, a larger proportion of non-white patients, headquarters in the South or West, and serving areas with more healthcare spending.
The authors also name specific health systems with the highest and lowest rates of low-value care use. The study team suggests that health systems could use this kind of system-level data “to develop incentive schemes to reduce unnecessary care, educate their workforce, or link hiring and retention decisions to use of low-value services.”
The findings suggest “that claims-based definitions can be used to measure low-value care within systems, providing granular, actionable feedback to promote health care quality and affordability,” Dr. Ganguli and colleagues write.
SOURCE: https://bit.ly/3mayHmE JAMA Internal Medicine, online September 27, 2021.
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