Assessing low-value care practices in the Netherlands

This recently published study looked at general practice and hospital routinely collected data in order to understand the volume and variation of selected low-value care practices. The analysis used billing claims from health care providers for 3.5 million Dutch inhabitants.

Three low-value practices were looked at: general practice ordering of imaging for low-back pain in the absence of red flags; hospitals that screened patients over 75 years for colorectal cancer; and hospitals that diagnosed varices with doppler or plethysmography.

The study showed there was a lot of variation in practice between providers. While many providers did not order these low-value tests, a minority ordered a substantial number.

This study reinforces the value of using routinely collected data to measure low-value practices and identifying variation in care as a tool for prioritising investigations to be targeted.

Choosing Wisely New Zealand recommendations are that imaging should not be used for diagnosing non-specific acute low back pain in the absence of red flags, nor should back imaging be part of routine medical examinations.


The full text is open access at The reference is Kool RB, et al. Assessing volume and variation of low-value care practices in the Netherlands, European Journal of Public Health, 17 Jan 2020, ckz245.