7.1: Understanding and quantifying low-value care

A comprehensive understanding of the concept of low-value care in health, aged and social care service delivery provides the opportunity to identify and address instances where this occurs. This is to improve the quality of care and safety for patients and clients as well as address the optimal and proportionate utilisation of finite resources throughout the healthcare system.

What is low-value care?

Use of an intervention where evidence suggest it confers no or very little benefit on patients, or risk of harm exceeds likely benefit, or, more broadly, the added costs of the intervention do not provide proportional added benefits. (Badgery-Parker et al., 2018)

Ineffective and inappropriate practices

Two key aspects of understanding situations and prevalence of low-value care involve ineffectiveness and the inappropriate use of practices and services. Where clinical and service interventions lack scientific evidence of justification the issues of efficacy or the ineffectiveness of such care needs to be seriously addressed and potentially removed or changed. Certain care can be identified as not offering benefit or improvement to an individual’s care and treatment and can be connected to leading to harm or adverse effects. Clinical and professional judgement is also required in terms of potential overutilisation of treatment and care where delivery of such services at higher frequency or intensity, without clear understanding of the benefits, can also constitute low-value care.

Resources (finance, workforce, consumables, time) are limited or finite at micro, meso and macro levels of the health and aged care sectors. Low-value care consumes healthcare resources and therefore is wasteful or inappropriate in terms of direct patient benefits or return on investment to a healthcare organisation or system. An important part of the agenda of dealing with low-value care is to ensure that a contemporary framework involving clinical guidelines and the practice of evidence-based medicine or clinical care is in place (Verkerk et al., 2018). The use of standards, guidelines, protocols and evidence-based medicine generally provides for identification of potential problems and issues as well as giving guidance around dealing with variability in clinical practices among healthcare providers within health systems. From these frameworks and guidance methods for dealing with low-value care, actions can be determined and referenced in order to deal with the issues of low-value care in practice and delivery.

The preferences of patients, clients and consumers are an important part of dealing with the complex issues of low-value care; patient preferences, understanding and values may not align with practice recommendations and the provision of care by healthcare professionals. There is a necessary correlation between patient and consumer information education and decision-making support within the agenda of dealing with low-value care.

Identifying low-value care

Several quantitative and qualitative methods or approaches can be used to identify and present situations and occurrences where low-value care may exist (Parker et al., 2022). Identification and articulation of patient care service outcomes, enabling an evaluation of results and impact of care following the receipt of clinical interventions, lets us determine whether benefits outweigh risks and costs. Services that do not result in improved patient health or quality of life can be indicative of low-value care. Associated with outcomes is the study of utilisation rates with analysis of specific clinical services, diagnostic tests or procedures and published clinical guidelines or evidence-based recommendations for practice and service delivery. Services provided at a higher rate than appropriate or necessary based on clinical evidence and practice guidelines can also indicate low-value care. Optimal review and assessment in the identification of low-value care probably involves several methods, to triangulate or provide granular evidence where low-value care might present. Monitoring an agreed set of performance indicators related to quality, safety, efficiency and efficacy enables the identification of practices, procedures and areas of improvement to reduce situations and circumstances of low-value care, to enhance the continuum of care provided to patients and consumers.