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

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.

Keywords: Low-value care; Measures; Performance measures; Quality improvement.

Fig. 1

Flow chart summarizing article selection

Fig. 2

Number of low-value care recommendations and measures categorized by the OECD/WHO/Eurostat Classification of Health Care Functions (n = 426)*. Admin.: Administrative; Alternative: Traditional, Complementary and Alternative Medicine; LTC: Long Term Care; Rehab.: Rehabilitative care; *We yielded 115 low-value care measures and 412 recommendations from the literature. Since 101 recommendations had a similar subjects as the measures, we subtracted these from 412 recommendations. That leaves 311 recommendations. Therefore, the total recommendations and measures in figure is 311 + 101 = 426