Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 3;19(1):446.
doi: 10.1186/s12913-019-4277-9.

Measuring the frequency and variation of unnecessary care across Canada

Zachary Bouck  1 , Ciara Pendrith  2 , Xi-Kuan Chen  3 , Jennifer Frood  3 , Ben Reason  3 , Tanya Khan  4 , Alicia Costante  3 , Kyle Kirkham  5 , Karen Born  6 , Wendy Levinson  7 , R Sacha Bhatia  8
Affiliations

Measuring the frequency and variation of unnecessary care across Canada

Zachary Bouck et al. BMC Health Serv Res. .

Abstract

Background: Through the Choosing Wisely Canada (CWC) campaign, national medical specialty societies have released hundreds of recommendations against health care services that are unnecessary, i.e. present little to no benefit or cause avoidable harm. Despite growing interest in unnecessary care both within Canada and internationally, prior research has typically avoided taking a national or even multi-jurisdictional approach in measuring the extent of the issue. This study estimates use of three unnecessary services identified by CWC recommendations across multiple Canadian jurisdictions.

Methods: Two retrospective cohort studies were conducted using administrative health care data collected between fiscal years 2011/12 and 2012/13 to respectively quantify use of 1) diagnostic imaging (spinal X-ray, CT or MRI) among Albertan patients following a visit for lower back pain and 2) cardiac tests (electrocardiogram, chest X-ray, stress test, or transthoracic echocardiogram) prior to low-risk surgical procedures in Alberta, Saskatchewan, and Ontario. A cross-sectional study of the 2012 Canadian Community Health Survey was also conducted to estimate 3) the proportion of females aged 40-49 that reported having a routine mammogram in the past two years.

Results: Use of unnecessary care was relatively frequent across all three services and jurisdiction measured: 30.7% of Albertan patients had diagnostic imaging within six months of their initial visit for lower back pain; a cardiac test preceded 17.9 to 35.5% of low-risk surgical procedures across Alberta, Saskatchewan, and Ontario; and 22.2% of Canadian women aged 40-49 at average-risk for breast cancer reported having a routine screening mammogram in the past two years.

Conclusions: The use of potentially unnecessary care appears to be common in Canada. This investigation provides methodology to facilitate future measurement efforts that may incorporate additional jurisdictions and/or unnecessary services.

Keywords: Choosing wisely; Low-value; Lower back pain; Mammography; Preoperative testing.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Risk-adjusted CT and MRI scan rates at 6 months after index visit for lower back pain by Albertan health zone
Fig. 2
Fig. 2
Physician- and facility-level variation in the proportion of low-risk surgical procedures with a preoperative cardiac test between June 2012 and March 2013 in Alberta and Saskatchewan
Fig. 3
Fig. 3
Proportion of Canadian women aged 40 to 49 who reported having a routine screening mammogram in the past two years despite being at average risk for breast cancer
See this image and copyright information in PMC

References

    1. Blumenthal-Barby JS. “Choosing wisely” to reduce low-value care: a conceptual and ethical analysis. J Med Philos. 2013;38(5):559–580. doi: 10.1093/jmp/jht042. - DOI - PubMed
    1. Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307:1801–1802. doi: 10.1001/jama.2012.476. - DOI - PubMed
    1. Levinson W, Huynh T. Engaging physicians and patients in conversations about unnecessary tests and procedures: choosing wisely Canada. CMAJ. 2014;186:325–326. doi: 10.1503/cmaj.131674. - DOI - PMC - PubMed
    1. Levinson W, Kallewaard M, Bhatia RS, Wolfson D, Shortt S, Kerr EA. ‘Choosing wisely’: a growing international campaign. BMJ Qual Saf. 2014;0:1–9. - PubMed
    1. Brownlee S, Chalkidou K, Doust J, Elshaug A, Glasziou P, Heath I, et al. Evidence of overuse of medical services around the world. Lancet. 2017;390(10090):156–168. doi: 10.1016/S0140-6736(16)32585-5. - DOI - PMC - PubMed

MeSH terms