Low-value procedures harm patients, consume hospital resources

The use of low-value procedures is harming patients, consuming hospital resources and delaying care for patients for whom the services would be appropriate, according to a new assessment of seven low-value procedures published in JAMA Internal Medicine.

The researchers, led by Tim Badgery-Parker, PhD candidate at the University of Sydney, sought to determine if patients who are admitted to the hospital for a low-value procedure develop hospital-acquired complications (HACs). Low-value procedures are typically those that would not be expected to require admission.

Specifically, they looked at endoscopy for dyspepsia, knee arthroscopy, colonoscopy for constipation, endovascular aneurysm repair (EVAR), carotid endarterectomy, renal artery angioplasty and spinal fusion.

Interventions to help curb low-value health services are in place, though less than 37 percent of physicians report comprehending the costs of tests and procedures to the healthcare system. The American Board of Internal Medicine’s Choosing Wisely initiative seeks to help medical professionals detect and avoid low-value health services. Still, more needs to be done.

Of 225 hospitals and 9,330 incidences of low-value care in New South Wales, Australia, the rates of HACs were low for low-value endoscopy for dyspepsia, knee arthroscopy and colonoscopy for constipation. The researchers noted the low HAC rates could be attributed to these procedures being relatively safe. That said, HAC rates were higher for low-value spinal fusion, EVAR, carotid endarterectomy and renal artery angioplasty.

“Low-value care carries the potential for harm," Badgery-Parker and colleagues wrote. "In this study, we identified HACs in 0.2 percent to 15 percent of low-value episodes, depending on the procedure. These procedures probably should not have been provided.”

The most common HACs were healthcare-associated infections—accounting for 26 percent of all HACs. Additionally, for all seven low-value procedures, the average length of stay for HAC patients was twice or more the average length of stay for patients without a complication.

The researchers noted a need for future work to better understand the consequences of low-value care to patients by reflecting on morbidity, mortality, readmission and patient-reported outcomes. Additionally, future work should compare the consequences of patients who receive appropriate care versus low-value care to study the impact of the additional burden of low-value care—including financial burdens.

“Although we restricted this study to seven low-value procedures and measured only some immediate in-hospital complications associated with these procedures, we found high rates of harm in some cases, with substantial additional lengths of stay,” the researchers concluded. “The full burden of low-value care for patients and the healthcare system is yet to be quantified.”