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Low-value care in Australian public hospitals: prevalence and trends over time
  1. Tim Badgery-Parker1,2,
  2. Sallie-Anne Pearson1,3,
  3. Kelsey Chalmers1,2,
  4. Jonathan Brett3,
  5. Ian A Scott4,5,
  6. Susan Dunn6,
  7. Neville Onley6,
  8. Adam G Elshaug1,7
  1. 1 Menzies Centre for Health Policy, School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
  2. 2 Health Market Quality Program, Capital Markets CRC, 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
  4. 4 School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
  5. 5 Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  6. 6 Activity Based Management, NSW Ministry of Health, Sydney, New South Wales, Australia
  7. 7 Lown Institute, Boston, Massachusetts, USA
  1. Correspondence to Professor Adam G Elshaug, Menzies Centre for Health Policy, The University of Sydney, Sydney, NSW 2006, Australia; elshaug{at}


Objective To examine 27 low-value procedures, as defined by international recommendations, in New South Wales public hospitals.

Design Analysis of admitted patient data for financial years 2010–2011 to 2016–2017.

Main outcome measures Number and proportion of episodes identified as low value by two definitions (narrower and broader), associated costs and bed-days, and variation between hospitals in financial year 2016–2017; trends in numbers of low-value episodes from 2010–2011 to 2016–2017.

Results For 27 procedures in 2016–2017, we identified 5079 (narrower definition) to 8855 (broader definition) episodes involving low-value care (11.00%–19.18% of all 46 169 episodes involving these services). These episodes were associated with total inpatient costs of $A49.9 million (narrower) to $A99.3 million (broader), which was 7.4% (narrower) to 14.7% (broader) of the total $A674.6 million costs for all episodes involving these procedures in 2016–2017, and involved 14 348 (narrower) to 29 705 (broader) bed-days. Half the procedures accounted for less than 2% of all low-value episodes identified; three of these had no low-value episodes in 2016–2017. The proportion of low-value care varied widely between hospitals. Of the 14 procedures accounting for most low-value care, seven showed decreasing trends from 2010–2011 to 2016–2017, while three (colonoscopy for constipation, endoscopy for dyspepsia, sentinel lymph node biopsy for melanoma in situ) showed increasing trends.

Conclusions Low-value care in this Australian public hospital setting is not common for most of the measured procedures, but colonoscopy for constipation, endoscopy for dyspepsia and sentinel lymph node biopys for melanoma in situ require further investigation and action to reverse increasing trends. The variation between procedures and hospitals may imply different drivers and potential remedies.

  • health services research
  • healthcare quality improvement
  • health policy

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  • Contributors TBP and KC jointly developed the indicators. TBP performed the analysis and drafted the article. JB and IS provided clinical input for indicator development. SD and NO facilitated access to the data, supervised the project and assisted in drafting the article. SAP and AE provided overall supervision and direction to the project and assisted in drafting the article. All authors read and approved the final article.

  • Funding This study is funded by the National Health and Medical Research Council (grant number 1109626), Capital Markets CRC, University of Sydney, NSW Ministry of Health, and HCF Research Foundation.

  • Competing interests TBP receives consulting fees and scholarship support from the Capital Markets Cooperative Research Centre and a University Postgraduate Award from the University of Sydney. KC receives personal fees from the Capital Markets Cooperative Research Centre and the Australian Federal Government via a Research Training Program Award and The University of Sydney. Prof Elshaug is a Board Member of the New South Wales Bureau of Health Information, receives salary support as the HCF Research Foundation Professorial Fellow, receives consulting/sitting fees from Cancer Australia, NPS MedicineWise (facilitator of Choosing Wisely Australia), the Australian Commission on Safety and Quality in Health Care (Atlas of Health Care Variation Advisory Group), the Queensland and Victoria Government Departments of Health, Private Healthcare Australia and the Australian Government Department of Health as an appointee to the MBS Review Taskforce. SAP, IAS, JB, SD, NO have no relevant disclosures.

  • Patient consent Not required.

  • Ethics approval The NSW Population and Health Services Research Ethics Committee approved this study (2015/09/607).

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

  • Data sharing statement This study used New South Wales hospital admitted patient data, and restrictions apply under the Health Records and Information Privacy Act 2002 (NSW). The authors can assist in accessing data upon reasonable request and with permission of the data custodian and approval from the NSW Population and Health Services Research Ethics Committee.

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