14 June 2018

Eva Verkerk, Marit Tanke and colleagues identified three types of unnecessary care that can help in selecting the best strategy to reduce it.

Although we strive for high-quality and valuable care, caregivers regularly provide low-value care: care without benefit for the patient. The concept of low-value care is broad and includes routine transthoracic echocardiograms for patients without symptoms, chronic use of benzodiazepines and curative treatment for patients that prefer palliative care.
 
Reducing low-value care makes healthcare safer for less costs, but stopping with care is hard. There is not one solution that works for all low-value care practices and contexts. Researchers of the Dutch national program ‘To do or not to do’ (www.doenoflaten.nl) identified three types of low-value care that can help in selecting the best strategy to reduce it.
 
The type ineffective care is medically ineffective. Inefficient care is medically effective, but is of low-value through inefficient provision or inappropriate intensity. Unwanted care is also medically appropriate for the condition it targets, but is of low-value since it does not fit the patients’ preferences. An example to illustrate this is the use of an MRI scan for a patient with a lumbal hernia. The MRI scan can be of low-value because the scan is not indicated (ineffective), because it had already been done at another hospital (inefficient), or because the patient prefers physiotherapy over an operation (unwanted).
 
The researchers discuss that these three types require different approaches to reduce. Ineffective care can be clearly defined, which enables automatic warnings in the ordering system, clear recommendations in guidelines or even reducing reimbursement: limit. For inefficient care, reorganizing care or facilitating cooperation are promising: lean. Unwanted care can be reduced by identifying the patients’ preferences and shared decision making: listen.
 
This typology provides insight in the three situations in which care is of low-value and what strategy might be helpful. The researchers hope to stimulate others to start reducing unnecessary care.

Publication
Limit, lean or listen? A typology of low-value care that gives direction in de-implementation.
Verkerk EW, Tanke MAC, Kool RB, van Dulmen SA, Westert GP.


All authors are members of theme Healthcare improvement science.
 

Related news items


Research into treatment for bladder pain syndrome will now be reimbursed

4 August 2021 Bladder pain syndrome, also called interstitial cystitis, is a chronic benign condition of the urinary bladder read more

Obesity increases risk of death in uterine cancer PhD defense of Hannah Donkers on 22 April

22 April 2021 Research by Hannah Donkers shows that obesity causes a worse survival rate in women with uterine cancer. In addition, it appears that lower socioeconomic class and anemia also contribute. read more

Patrick Jeurissen member Scientific Advisory Board for European Commission on health care policy in pandemics

26 November 2020 Patrick Jeurissen, Professor of Affordability of Care, has been appointed as a member of the Scientific Advisory Board for the Pan-European Commission on Health and Sustainable Development. This committee will study healthcare policy in the light of pandemics in the coming year. read more

Physiotherapy is important to the recovery of patients with the coronavirus

26 March 2020 Patients who have been infected with the coronavirus and admitted to the hospital for this reason should receive physiotherapy as soon as their condition allows. This is the view expressed by physiotherapists and researchers from the Radboudumc in a set of joint treatment recommendations. read more