Study Describes Health System Characteristics Linked to Low-Value Care
A study recently published in the JAMA Network identifies characteristics of health systems associated with higher rates of low-value care, including a smaller proportion of primary care physicians and no major teaching hospital in the area.
The retrospective cohort study of health system–attributed Medicare beneficiaries was conducted among 556 health systems in the Agency for Healthcare Research and Quality Compendium of U.S. Health Systems and included system-attributed beneficiaries who were older than 65 years, continuously enrolled in Medicare Parts A and B for at least 12 months in 2016 or 2017, and eligible for specific low-value services.
Other attributes connected with higher levels of low-value care include a larger proportion of non-white patients, being headquartered in the South or West and serving areas with more healthcare spending.
The study’s definition of low-value care was based on the Milliman MedInsight Health Waste Calculator and published claims-based definitions. The most common low-value services were preoperative laboratory testing, prostate-specific antigen testing in men older than 70 years, and use of antipsychotic medications in patients with dementia.
The lead author on the study is Ishani Ganguli, M.D., M.P.H., an assistant professor of medicine and a primary care physician at Harvard Medical School and Brigham and Women’s Hospital Division of General Internal Medicine and Primary Care.
The co-authors note that to date efforts to address low-value care have largely been restricted to the national or regional level, limiting their usefulness and impact. They added that the study shows that “system-level measurement and reporting of specific low-value services is feasible, enables cross-system comparisons, and reveals a broad range of low-value care use.”
