Table 1

Measuring low-value care according to two lenses ((A) patient and (B) service) and three measures using a case example from Scott et al 14

Numerator of measurePatients with the low-value indication and the service 
For example, 8955 US Medicare beneficiaries with syncope* that underwent carotid ultrasound
Denominator of measureBased on patients with specific indicationBased on all patients (or people) in the cohortBased on specific services
For example, 55 140 beneficiaries with syncope*For example, 1 340 908 beneficiariesFor example, 137 424 beneficiaries underwent a carotid ultrasound
FindingsPercentage with a specific indication receiving low-value servicePercentage of total receiving a low-value servicePercentage of services that are low-value services
For example, 16.2% of beneficiaries with syncope* had a carotid ultrasoundFor example, 0.7% of beneficiaries had a carotid ultrasound and syncope*For example, 6.5% of beneficiaries who received a carotid ultrasound presented with syncope*
Main audienceClinicians: gives information on the proportion of patients with specific indication or population receiving low-value care
Policy makers/resource allocation: proportion of services used that are low-value
  • *Syncope was defined as a syncopal episode not accompanied by focal neurological signs or symptoms suggestive of stroke.14 According to the various sources CDUS should only be used for patients presenting with concerns of stroke, transient ischaemic attacks, focal neurological signs or carotid bruits.18–21

  • CDUS, carotid duplex ultrasound.