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      Are low-value care measures up to the task? A systematic review of the literature

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          Abstract

          Background

          Reducing low-value care is a core component of healthcare reforms in many Western countries. A comprehensive and sound set of low-value care measures is needed in order to monitor low-value care use in general and in provider-payer contracts. Our objective was to review the scientific literature on low-value care measurement, aiming to assess the scope and quality of current measures.

          Methods

          A systematic review was performed for the period 2010–2015. We assessed the scope of low-value care recommendations and measures by categorizing them according to the Classification of Health Care Functions. Additionally, we assessed the quality of the measures by 1) analysing their development process and the level of evidence underlying the measures, and 2) analysing the evidence regarding the validity of a selected subset of the measures.

          Results

          Our search yielded 292 potentially relevant articles. After screening, we selected 23 articles eligible for review. We obtained 115 low-value care measures, of which 87 were concentrated in the cure sector, 25 in prevention and 3 in long-term care. No measures were found in rehabilitative care and health promotion. We found 62 measures from articles that translated low-value care recommendations into measures, while 53 measures were previously developed by institutions as the National Quality Forum. Three measures were assigned the highest level of evidence, as they were underpinned by both guidelines and literature evidence. Our search yielded no information on coding/criterion validity and construct validity for the included measures. Despite this, most measures were already used in practice.

          Conclusion

          This systematic review provides insight into the current state of low-value care measures. It shows that more attention is needed for the evidential underpinning and quality of these measures. Clear information about the level of evidence and validity helps to identify measures that truly represent low-value care and are sufficiently qualified to fulfil their aims through quality monitoring and in innovative payer-provider contracts. This will contribute to creating and maintaining the support of providers, payers, policy makers and citizens, who are all aiming to improve value in health care.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12913-016-1656-3) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references 38

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          Measuring low-value care in Medicare.

          Despite the importance of identifying and reducing wasteful health care use, few direct measures of overuse have been developed. Direct measures are appealing because they identify specific services to limit and can characterize low-value care even among the most efficient providers.
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            'Choosing Wisely': a growing international campaign.

            Much attention has been paid to the inappropriate underuse of tests and treatments but until recently little attention has focused on the overuse that does not add value for patients and may even cause harm. Choosing Wisely is a campaign to engage physicians and patients in conversations about unnecessary tests, treatments and procedures. The campaign began in the United States in 2012, in Canada in 2014 and now many countries around the world are adapting the campaign and implementing it. This article describes the present status of Choosing Wisely programs in 12 countries. It articulates key elements, a set of five principles, and describes the challenges countries face in the early phases of Choosing Wisely. These countries plan to continue collaboration including developing metrics to measure overuse.
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              Choosing wisely--the politics and economics of labeling low-value services.

              More than 40 medical specialties have identified "Choosing Wisely" lists of five overused or low-value services. But these services vary widely in potential impact on care and spending, and specialty societies often name other specialties' services as low value.
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                Author and article information

                Contributors
                +31(0)30-2743861 , eline.de.vries@rivm.nl
                jeroen.struijs@rivm.nl
                richard.heijink@rivm.nl
                roy.hendrikx@rivm.nl
                caroline.baan@rivm.nl
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                18 August 2016
                18 August 2016
                2016
                : 16
                Affiliations
                [1 ]Department Tranzo (Scientific Center for Care and Welfare), Tilburg University, Tilburg School of Social and Behavioral Sciences, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
                [2 ]Department of Quality of Care and Health Economics, National Institute of Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
                Article
                1656
                10.1186/s12913-016-1656-3
                4990838
                27539054
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100007192, Rijksinstituut voor Volksgezondheid en Milieu;
                Award ID: SPR S/133002
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Health & Social care

                performance measures, low-value care, measures, quality improvement

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