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Quantifying low-value care: a patient-centric versus service-centric lens
  1. Kelsey Chalmers1,2,
  2. Sallie-Anne Pearson1,3,
  3. Adam G Elshaug1
  1. 1 School of Public Health, Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Health Market Quality, Capital Markets CRC Ltd, Sydney, New South Wales, Australia
  3. 3 Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Kelsey Chalmers, School of Public Health, Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales 2006, Australia; kelsey.chalmers{at}

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Low-value healthcare has been defined as care that is inappropriate for a specific clinical indication, inappropriate for a clinical indication in a specific population or an excessive frequency of services relative to expected benefit.1 Quantifying the prevalence of low-value healthcare informs clinicians and health policy makers on the use and associations of unwarranted care.2 In this Viewpoint, we clarify the approaches used in the literature for measuring and reporting the level of low-value care in a given population. Categorising low-value service measures depends on the denominator used. Future analyses should consider using all types of measures when possible, or explain why it is not practical or desirable to do so, and at the very least describe for the reader which measure has been used, as this can dramatically impact interpretation of the results.

Low-value care: listed and (variably) measured

Defining, quantifying and reducing low-value healthcare are important co-dependent issues with an increasing focus in the literature.3 4 Lists or guidelines defining low-value services for given patient populations are now mushrooming.5 Choosing Wisely, for example, is a prominent international movement promoting lists of recommendations on low-value services that offer no or very limited benefit to patients under specific circumstances.6 Interventions targeting the reduction of low-value or no-value care offer the dual benefit of improving safety and quality and making inroads into escalating healthcare expenditure.7

Playing catch-up to list generation (particularly outside of the USA) is the measurement movement; work that quantifies the proportion, characteristics and trends in low-value care.3 8 9 It is curious that low-value lists abound, yet the world over we have but a cursory understanding of the scale and scope of low-value care due to the general lack of measurement.3 Not surprisingly then, a growing number of population-based measurement studies are surfacing through the rubric of …

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  • Contributors KC prepared the original draft and review (details of the review are in the supplementary appendix), and S-AP and AE contributed to concept design, articulation and final submission. KC is the guarantor of the article.

  • Competing interests KC receives personal fees from the Capital Markets Cooperative Research Centre and the Australian Federal Government via an Australian Postgraduate Award, and The University of Sydney; AGE receives salary support as the HCF Research Foundation Professorial Research Fellow, receives consulting sitting fees from Cancer Australia, the Capital Markets Cooperative Research Centre-Health Quality Program, NPS MedicineWise (facilitator of Choosing Wisely Australia), The Royal Australasian College of Physicians (facilitator of the EVOLVE programme) and the Australian Commission on Safety and Quality in Health Care; SAP is a member of the Drug Utilization Sub-Committee of the Pharmaceutical Benefits Advisory Committee (PBAC) and receives consulting fees from NPS MedicineWise.

  • Provenance and peer review Not commissioned; externally peer reviewed.